The following is a summary of “Simulation of New York City’s Ventilator Allocation Guideline During the Spring 2020 COVID-19 Surge,” published in the October 2023 issue of Critical Care Medicine by Walsh et al. 

During the spring 2020 COVID-19 surge in New York City, the strain on ventilator availability led hospitals to contemplate implementing crisis standards of care and the New York Ventilator Allocation Guidelines (NYVAG). 

For a study, researchers evaluated NYVAG’s performance during the surge in patient numbers, assessing rationing duration, mortality rates, and health disparities among intubated patients in a single NYC health system from March to July 2020. They conducted 20,000 simulations, comparing ventilator triage following NYVAG and an improved proposed NYVAG during a crisis.

The study involved 1,671 patients; 674 were intubated during the crisis, and 84.7% tested positive for COVID-19. Simulated ventilator rationing affected 163.9 patients over 15.0 days. Of these, 44.4% would have survived if given a ventilator, compared to 34.8% survival with reallocated ventilators for newly intubated patients. Nearly all ventilator rationing occurred after intubation, with 43.1% remaining intubated for over 7 days despite a favorable SOFA score. Revising NYVAG guidelines could have improved efficiency, raising the survival rate to 25.3%.

Findings indicated that NYVAG led to the allocation of ventilators away from patients with higher survival prospects toward those with lower chances. To address this inefficiency, future efforts should prioritize refining triage subcategories and reconsidering ventilator rationing, especially after the initial time trial when most of it occurred.

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2810189