A retrospective evaluation of three ethical triage tools for the allocation of ICU resources during the first wave of the COVID-19 pandemic

PURPOSE: To retrospectively evaluate the effect of ethical triage tools (ETT), designed to streamline the admission of patients during the first wave of the COVID-19 pandemic. We aimed to determine the characteristics and outcomes of the patients who would have been denied admission to the ICU according to these protocols, including the cumulative number of saved ICU days. METHODS: We retrospectively identified the ethical triage status in every patient who was admitted to our 31-bed mixed ICU in Antwerp, Belgium during the first wave of the COVID-19 pandemic, regardless of the reason for admission. This study was possible since the capacity of our ICU had not been threatened, still enabling our usual case-per-case decision. We evaluated three different ETTs that were designed in our and two other hospitals during the COVID-19 pandemic. RESULTS: During the 81-day study period, 182 patients were admitted to the ICU. Of the patients, 9–23% would have been denied ICU admission according to the three assessed ETTs (WBD cohort), responsible for 8–18% (n = 116–257) of the total number of ICU days. Of the WBD patients, 44–55% eventually survived their hospital stay, compared to 71–74% of the patients that would have been allowed admission. Of the WBD patients admitted for respiratory failure due to COVID-19, 18–25% survived, a number that decreased to 0–20% when these patients required mechanical ventilation. CONCLUSION: An ETT effectively reduces ICU bed occupancy but it does not accurately discriminate between survivors and non-survivors, as a substantial percentage of patients who are being denied admission to the ICU would eventually survive their hospital stay.