Coronavirus or not, choosing whether or not to place a patient on an artificial respirator is the daily lot of resuscitators. But the current epidemic risks forcing them to a large-scale “sorting” raising ethical questions.

Coronavirus or not, choosing whether or not to place a patient on an artificial respirator is the daily lot of resuscitators. But the current epidemic risks forcing them to a large-scale “sorting” raising ethical questions.

(.) – The Covid-19 pandemic has already claimed more than 13,000 lives worldwide and more than 308,000 cases are officially listeds. And the seriously ill require very heavy resuscitation, causing saturation of hospitals in some countries, which could extend to others.

Under these conditions, which patient should benefit from a respirator? Of good practice guidelines have been around for a long time, want to reassure the resuscitators. “We are not starting from scratch, these are decisions we make every day,” explains Bertrand Guidet, head of the intensive care intensive care unit at Saint-Antoine hospital in Paris.

Companies and individuals are stepping up assistance to caregivers in Luxembourg health establishments. Solidarity appreciated by the teams and often very useful.

To make this choice, three evaluation criteria, which also apply for the coronavirus:the patient’s wish“, his general health and the severity of the disease, he specifies. Regarding the patient’s wish, the doctor also calls on families to discuss it beforehand, because resuscitation is “very heavy” for severe cases of covid-19, with significant possible sequelae in the event of survival especially for the most fragile.

Resuscitation can be “unreasonable”

“You find yourself for three weeks with a machine that breathes for you, you are asleep, you are paralyzed with curares,” he insists. So, whether or not there is enough space, resuscitation can be “unreasonable”, experts insist, noting that patients can then be referred to palliative care.

But in the event of a crisis, from earthquakes to waves of attacks, and of course for the coronavirus, the criteria for resuscitation can harden, with an influx of patients facing limited means. “Yes, we will be called to prioritize the sick. If we take the words of President (French) Emmanuel Macron, we are at war, well it’s called sorting, like on the battlefield where we leave seriously injured because we think they will die ” , underlines Dr. Guidet.

“At that time, we give the respirator whoever has the best chance of survival“Explains Dr Philippe Devos, resuscitator in Liège, Belgium, to ..

“Huge moral weight”

“Insofar as the means available, we will try to ensure that it is not a lottery,” he continues, highlighting a set of criteria to be associated, such as age and the underlying diseases. While the number of patients is increasing, it is also necessary to “hold over time”, underlines Dr Guidet.

With dozens of officially registered infections, the Grand Duchy has chosen to take drastic measures to limit the spread of covid-19. Measures that impact the daily lives of 614,000 residents and 200,000 cross-border residents of the country.

“The patients who present themselves now must not be privileged over those who will arrive in a week or 15 days, we must not saturate everything immediately”.

In Italy, now the most affected country in the world, hospitals are already saturated and doctors are doing what they can. “We cannot try to obtain a miracle (…) We try to save only those who have a chance”, recently told Corriere della Serra Christian Salaroli, resuscitator in a hospital in Bergamo. “We decide by age, by health condition. As in all war situations ”.

In early March, faced with the saturation of Italian hospitals, the Italian Society of Anesthesia, Resuscitation and Intensive Care even considered an age limit for admission to intensive care. A recommendation that is not unanimous. “Age alone, no,” insists Dr Guidet, recounting having admitted to intensive care a serious patient of the Covid-19 aged 85, without any history and completely autonomous until then. While a quarantine reaches a last degree cirrhosis and who continues to drink there would be no place.

Those are the same principles that for organ transplant waiting lists, comments Arthur Caplan of the Groceman School of Medicine at New York University. “People have been dying every day for decades because they cannot be transplanted,” said the bioethics specialist at .. “We don’t have enough organs (…), the system is to give them to the person who is most likely to get out of it.”

But for the coronavirus, despite the rules or recommendations, at the end, it is the resuscitator at the controls who will make the decision, sometimes in the middle of the night and in emergency, alone or in a team, he believes. A “huge moral weight” to bear, says Dr. Devos.

“We do the maximum so that this situation does not arise and that if it were to come, it could be accompanied, patient by patient, doctor by doctor, by ethical cells “, said Sunday the Minister of Health Olivier Veran on RTL / LCI / Le Figaro, who asked for such cells “in all hospitals to be able to support caregivers in this type of decision, should they arise”.

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