Operationalizing Ethical Guidance for Ventilator Allocation in Minnesota: Saving the Most Lives or Exacerbating...

Area of Science:

• Critical Care Medicine
• Public Health Policy
• Health Equity

Background:

• A statewide working group developed a ventilator allocation scoring system for crisis standards of care.
• The system was intended for patients with and without COVID-19.
• Concerns were raised regarding potential exacerbation of health disparities and the inclusion of age.

Purpose of the Study:

• To evaluate the relationship between the Ventilator Allocation Score and patient mortality.
• To analyze the score's utility and ethical implications in scarce resource allocation.
• To assess potential biases related to age and comorbidities.

Main Methods:

• Retrospective cohort study.
• Analysis of 504 patients emergently intubated and admitted to the ICU within a single healthcare system.
• Measurement of in-hospital and 3-month mortality in relation to the Ventilator Allocation Score.

Main Results:

• The Ventilator Allocation Score positively correlated with higher mortality (p < 0.0001).
• Patients with a score of 6 or higher had a 96% 3-month mortality rate.
• Age was associated with mortality; patients 80+ with scores ≥4 had 93% 3-month mortality.

Conclusions:

• The Ventilator Allocation Score identifies high short-term mortality but has limited utility for scarce resource allocation.
• The score may unfairly prioritize older patients and exacerbate racial disparities via comorbidities.
• Triage frameworks require careful consideration of age and proactive measures against perpetuating inequities.