April 2, 2020

Our take: Why the new 'ventilator splitting' guideline should be a last resort

Daily Briefing

    Federal health officials in an open letter to U.S. health care workers on Tuesday said hospitals may split one ventilator between two COVID-19 patients to keep up with demand for the life-saving technology—though the practice should be used only "as an absolute last resort," the letter said.

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    Background

    While companies like Ford and General Electric are ramping up production to the tune of 50,000 ventilators in the next 100 days, experts say the production timeline lags current projections for COVID-19's peak. Even if there is a surge of ventilators ready for purchase, the United States lacks a centralized allocator of critical supplies, forcing hospitals and state and federal governments to compete for available ventilators.  

    New guidelines recommends ventilator splitting as 'last resort'

    In response to the situation, Surgeon General Jerome Adams and Assistant Secretary for Health Brett Giroir in the letter released Tuesday said that, in "order to meet the growing demand" of mechanical ventilators, hospitals will have to optimize their use by canceling elective surgeries, using equipment from regions that are not experiencing outbreaks, and transitioning anesthesia machines and other devices for mechanical support.

    In addition to these measures, the guidelines said that providers may turn to a "crisis standard of care strategy": Splitting a single mechanical ventilator between two patients. The patients sharing the ventilator must either not have COVID-19 or both have COVID-19.

    The practice of ventilator splitting has been used very rarely and the safety of the practice remains undetermined. In fact last week, some groups representing critical care providers cautioned against the practice, saying "it cannot be done safely with current equipment."

    Given the safety concerns, Adams and Giroir said the strategy "should only be considered as an absolute last resort" and only "if a hospital cannot provide clinically proven, reliable, and safe methods to manage acute respiratory failure."

    The officials in the guidelines said the decision to split ventilators "must be made on an individual institution, care-provider, and patient level."

    The officials noted that several institutions are currently developing and testing protocols for the practice and evaluating its use in hospitals that are currently overwhelmed with COVID-19 patients. Moreover, some hospitals have "preliminarily implemented" the practice, the officials wrote. At least one hospital in New York, for instance, has already started splitting ventilators between patients, Politico reports. In addition, some hospitals in Italy tried the strategy when they were overrun with COVID-19 patients (Weixel, The Hill, 3/31; Roubein, Politico, 3/31; Reuters/New York Times, 3/30; HHS letter, 3/31).

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