Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic: Clinical and ethical recommendations of DIVI, DGINA, DGAI, DGIIN, DGNI, DGP, DGP and AEM

Marckmann, Georg; Neitzke, Gerald; Schildmann, Jan; Michalsen, Andrej; Dutzmann, Jochen; Hartog, Christiane; Jöbges, Susanne; Knochel, Kathrin; Michels, Guido; Pin, Martin; Riessen, Reimer; Rogge, Annette; Taupitz, Jochen; Janssens, Uwe

In view of the globally evolving coronavirus disease (COVID-19) pandemic, German hospitals rapidly expanded their intensive care capacities. However, it is possible that even with an optimal use of the increased resources, these will not suffice for all patients in need. Therefore, recommendations for the allocation of intensive care resources in the context of the COVID-19 pandemic have been developed by a multidisciplinary group of authors with the support of eight scientific medical societies. The recommendations for procedures and criteria for prioritisations in case of resource scarcity are based on scientific evidence, ethicolegal considerations and practical experience. Medical decisions must always be based on the need and the treatment preferences of the individual patient. In addition to this patient-centred approach, prioritisations in case of resource scarcity require a supraindividual perspective. In such situations, prioritisations should be based on the criterion of clinical prospect of success in order to minimize the number of preventable deaths due to resource scarcity and to avoid discrimination based on age, disabilities or social factors. The assessment of the clinical prospect of success should take into account the severity of the current illness, severe comorbidities and the patient’s general health status prior to the current illness. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00063-020-00709-9) includes Fig. 1 “Documentation support for prioritisation in case of resource scarcity” and Fig. 2 “Flowchart—decision-making in the case of insufficient intensive care resources” for download. Contributions and additional material are available at www.springermedizin.de. Please enter the article title in the search field, the additional material can be found under “Ergänzende Inhalte”.