Respiratory failure & ventilation
Simulation of New York City’s Ventilator Allocation Guideline During the Spring 2020 COVID-19 Surge
Authors' conclusion
In this cohort study of intubated patients experiencing simulated ventilator rationing during the apex of the New York City COVID-19 2020 surge, NYVAG diverted ventilators from patients with a higher chance of survival to those with a lower chance of survival.
Study context
- Population
- Intubated patients in a single New York City health system, March–July 2020 (COVID-19 surge), crisis period = prepandemic ventilator supply 95% utilized674 in crisis period
- Participants
- 1,671 patients
- Exposure
- Simulated NYVAG ventilator rationing vs proposed improved NYVAG vs observed survival
- Outcome
- Observed survival rates compared with simulations of scenarios requiring NYVAG ventilator rationing
Methodological detailssingle health system, 20 000 simulations
- Single health system
- 20 000 simulations
Main finding
As reported in the abstract
Patients undergoing simulated ventilator rationing
163.9
Duration of simulated rationing (days)
15.0
Rationed patients who would have survived if provided a ventilator
44.4%
95% CI 38.3%–50.0%
Newly intubated patients receiving a reallocated ventilator who survived
34.8%
95% CI 28.5%–40.0%
Observational data: associations, not effects.
Further findings
- Rationed patients who would have survived if provided a ventilator (proposed improved NYVAG) — Proposed improved NYVAG
- 25.3% (95% CI 22.1%–28.4%)
Timing of rationing
- Ventilator rationing occurring after a time trial
- 94.8%
- Of these, intubated ≥7 days with favorable, unimproved SOFA score
- 43.1%
- Estimated survival of these patients if sustained on a ventilator
- 60.6%
Health disparities
- NYVAG ventilator rationing did not exacerbate existing health disparities
Original publication
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