Background: The COVID-19 pandemic has overwhelmed healthcare systems all over the world. Many countries have formulated guidelines for a scenario in which ICU triage is needed: when there are more patients requiring ICU beds than there are beds available. In this study, we provide an overview of how the Dutch ICU triage guidelines compare with the guidelines of other countries.
Methods: All triage grounds were extracted from the guidelines of the Netherlands, Belgium, Germany, United Kingdom, Italy, Switzerland, Australia & New Zealand, Canada and South Africa.
Results: The Netherlands has one of the most clearly operationalised and presented guidelines. The most important Dutch triage ground – maximising benefits – is also a central triage ground in other countries, although which benefits are maximised differs: saving the most lives or also saving the most life years with the best quality of life. Other differences are whether prioritising younger patients irrespective of medical arguments is acceptable, whether patients already in the ICU should be triaged along with patients waiting for a bed and the choice of ‘last resort’ strategy.
Conclusion: The most important ICU triage ground for all countries in this comparison is ‘maximising benefits’. However, which benefits are maximised exactly and to what extent this is operationalised in each of the guidelines differs. Unlike the Netherlands, most countries in this comparison did not describe step-by-step guidelines. The Netherlands therefore appears to be one step ahead of many other countries when it comes to preparedness for a situation in which ICU triage is needed.
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