@article{TEXTUAL,
      recid = {11172},
      author = {Piscitello, Gina M. and Kapania, Esha M. and Miller,  William D. and Rojas, Juan C. and Siegler, Mark and Parker,  William F.},
      title = {Variation in ventilator allocation guidelines by us state  during the coronavirus disease 2019 pandemic: A systematic  review},
      journal = {JAMA Network Open},
      address = {2020-06-19},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Importance: During the coronavirus disease 2019  pandemic, there may be too few ventilators to meet medical  demands. It is unknown how many US states have ventilator  allocation guidelines and how these state guidelines  compare with one another.&lt;/p&gt; &lt;p&gt;Objective: To evaluate the  number of publicly available US state guidelines for  ventilator allocation and the variation in state  recommendations for how ventilator allocation decisions  should occur and to assess whether unique criteria exist  for pediatric patients.&lt;/p&gt; &lt;p&gt;Evidence Review: This  systematic review evaluated publicly available guidelines  about ventilator allocation for all states in the US and in  the District of Columbia using department of health  websites for each state and internet searches. Documents  with any discussion of a process to triage mechanical  ventilatory support during a public health emergency were  screened for inclusion. Articles were excluded if they did  not include specific ventilator allocation recommendations,  were in draft status, did not include their state  department of health, or were not the most up-to-date  guideline. All documents were individually assessed and  reassessed by 2 independent reviewers from March 30 to  April 2 and May 8 to 10, 2020.&lt;/p&gt; &lt;p&gt;Findings: As of May  10, 2020, 26 states had publicly available ventilator  guidelines, and 14 states had pediatric guidelines. Use of  the Sequential Organ Failure Assessment score in the  initial rank of adult patients was recommended in 15 state  guidelines (58%), and assessment of limited life expectancy  from underlying conditions or comorbidities was included in  6 state guidelines (23%). Priority was recommended for  specific groups in the initial evaluation of patients in 6  states (23%) (ie, Illinois, Maryland, Massachusetts,  Michigan, Pennsylvania, and Utah). Many states recommended  exclusion criteria in adult (11 of 26 states [42%]) and  pediatric (10 of 14 states [71%]) ventilator allocation.  Withdrawal of mechanical ventilation from a patient to give  to another if a shortage occurs was discussed in 22 of 26  adult guidelines (85%) and 9 of 14 pediatric guidelines  (64%).&lt;/p&gt;&lt;p&gt;Conclusions and Relevance: These findings  suggest that although allocation guidelines for mechanical  ventilatory support are essential in a public health  emergency, only 26 US states provided public guidance on  how this allocation should occur. Guidelines among states,  including adjacent states, varied significantly and could  cause inequity in the allocation of mechanical ventilatory  support during a public health emergency, such as the  coronavirus disease 2019 pandemic.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/11172},
}