Triage for ECMO and Other Critical Care Resources in Widespread Equipment Shortage

How can #hospitals and health systems prepare for ethical and practical challenges presented by widespread shortages of certain critical care resources? When life-threatening shortages may arise with little notice, how can #organizations quickly build multi-stakeholder support for a fair and workable approach to triage and resource-sharing? Is there a role for inter-institutional collaboration in short- or longer-term planning?
Many institutions recently faced an impending shortage of ECMO circuits due to a scarcity of available oxygenators. With a few weeks’ notice and with the sponsorship of hospital leaders, Seattle Children’s Hospital used a broad existing triage algorithm developed through regional disaster response refined during #COVID19 as a basis for creating a similar algorithm and triage process specifically for ECMO allocation. ECMO physicians from the neonatal, pediatric and cardiac ICUs, surgeons, organizational ethics, the center for health equity and diversity, hospital leadership and risk management met frequently to develop and finalize a standard operating procedure. Panelists discussed challenges and lessons learned in that process, in light of anticipated needs for similar efforts as other shortages occur.
Presentations by Emily R. Berkman, MD, MA, Douglas S. Diekema MD, MPH, and Mithya Lewis-Newby, MD, MPH, with Matthew Wynia, MD, MPH, FACP as discussant, and Charlotte H. Harrison, PhD, JD, MPH, HEC-C as moderator. Support provided by the Oswald DeN. Cammann Fund at Harvard University.