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SESSION TITLE: Disaster Medicine Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: COVID-19 created significant strain on the supply of ventilators in New York City and many hospitals prepared resource allocation policies should the demand exceed supply Available resource allocation guidelines depend on objective variables for allocation and reallocation decisions, however little attention has been focused on reallocation strategies In such a scenario, resources should remain allocated to patients most likely to survive with the smallest increment in committed resources Understanding how these guidelines perform in the context of a novel pathogen is an important consideration in disaster planning Numerous allocation guidelines exist however nearly all utilize a Sequential Organ Failure Assessment (SOFA) score, and many are very similar We sought to evaluate the performance of ventilator reallocation by applying the New York State Ventilator Allocation Guidelines to a cohort of COVID-19 patients METHODS: A retrospective cohort study of the first 50 intubated COVID-19 patients admitted to an ICU at a one tertiary referral center and two community hospitals in New York City SOFA scores were calculated at time of intubation, 48 hours, 120 hours, and 168 hours after intubation Per the New York Guidelines, patients would have their ventilator reallocated at 48 hours if their interval SOFA score increased, did not change from an initial SOFA of 8-11, or was greater than 11 At 120 hours it would be reallocated if their SOFA score worsened or was greater than 7 At 168 hours it would be reallocated if their SOFA score worsened Ventilator reallocation was simulated and no reallocation was made for any patient RESULTS: The average SOFA (n=48) at the time of intubation was 6 1 ± 2 5 At the 48-hour assessment (average SOFA 6 9 ± 3 1, n=48), 26 (54%) patients would have their ventilator reallocated, 3 (12%) of whom would later be extubated At the 120-hour assessment (average SOFA 7 1 ± 2 9, n=43) 12 (67%) of the remaining simulated ventilated patients would have their ventilators reallocated, 4 (33%) of whom would otherwise later be extubated At the 168-hour assessment (average SOFA 7 6 ± 3 3, n=41) 4 (80%) of the simulated remaining ventilated patients would have their ventilators reallocated 42 patients (88%) of the cohort would have had their ventilator reallocated at some time during the 168-hour observation period, 9 (21%) of whom would later be extubated CONCLUSIONS: Tertiary triage will likely occur if ventilators are rationed according to current guidelines during a COVID-19 pandemic This may have implications for disaster planning and resource allocation policies in areas impacted by outbreaks of COVID-19 CLINICAL IMPLICATIONS: Challenges persist regarding the appropriate length of a ventilator time trial for a novel disease Patients should be prioritized for ventilator reallocation that is proportional to their mortality and to the strain on the scarce resource DISCLOSURES: No relevant relationships by Vikramjit Mukherjee, source=Web Response, value=Consulting fee Removed 04/27/2020 by Vikramjit Mukherjee, source=Web Response No relevant relationships by Amit Uppal, source=Web Response No relevant relationships by Brandon Walsh, source=Web Response
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