Managing Older Adults With Presumed COVID-19 in the Emergency Department

A Rational Approach to Rationing

Tony Rosen, MD MPH; Lauren E. Ferrante, MD MHS; Shan W. Liu, MD SD; Emily A. Benton, MD; Mary R. Mulcare, MD; Michael E. Stern, MD; Kevin Biese, MD; Ula Hwang, MD MPH; Martine Sanon, MD


J Am Geriatr Soc. 2020;68(8):1631-1635. 

In This Article

Balancing Medical Futility and Exposure Risk

Attempting to resuscitate a patient after cardiac arrest, which may require emergent intubation and also involves aerosolization of secretions during chest compressions, is a high-risk procedure for providers during the COVID pandemic. As a result, part of "rationing" involves decisions about whether to initiate cardiopulmonary resuscitation (CPR) and what is considered acceptable duration of these resuscitation efforts. The decision to initiate and continue CPR requires the care team to weigh the risks and benefits to the patient, while also considering the potential risk to providers. Health systems and hospitals should have clear guidelines about circumstances in which CPR should be performed and how medical futility should be determined. These protocols should include the outline of specific steps to minimize the risk to providers from aerosolized particles during CPR. It is concerning that age may be used, even subconsciously, as a determinant when these decisions are made at the bedside. Age is only one small factor that informs likelihood of survival with a positive outcome after cardiac arrest.