Trump Administration Medical Panel Devises Ventilator-Sharing Protocol

The Trump administration has prepared a protocol for how to split ventilators among multiple Covid-19 patients that could be released as soon as today, according to two doctors working on it, even as the president has suggested the U.S. won’t run short of the critical device.

As members of a medical panel raced to post information online about how to complete the novel procedure, hospitals in New York and Italy reported that they have “co-ventilated” Covid-19 patients for the first time.

Ventilators are designed to be used on one patient at a time, but there is broad concern that the U.S. doesn’t have enough ventilators to support all the Covid-19 patients that might need them.

On Wednesday, a collection of medical experts in the field gathered in Washington at a meeting sponsored by Department of Health and Human Services assistant secretary Brett Giroir, along with other federal agencies charged with handling Covid-19 response efforts. Their task was to design a last-ditch protocol to split ventilators, so doctors aren’t left to make the agonizing choice of who lives or dies.

“When you realize that you’re running low on your last few vents, you’ll have to start making this decision,” said U.S. Air Force Maj. Dr. Lorenzo Paladino, an associate professor at SUNY Downstate Health Sciences University in Brooklyn. In 2008, Dr. Paladino successfully split one ventilator among four sheep for 12 hours.

He compared the group’s efforts, trying to get a message to doctors who have never used ventilators in this manner before, to the safety briefing airline passengers get before a water landing. “Flight attendants can’t communicate how to put on a life jacket after impact. We need to prep for the worst case before the chaos and panic actually hits.”

President Trump himself has played down what officials including New York Gov. Andrew Cuomo have described as a dire shortage of ventilators. In an interview with Fox News host Sean Hannity on Thursday, President Trump said “I don’t believe you need 40,000 or 30,000 ventilators,” apparently referring to Gov. Cuomo’s comments. “You know, you go into major hospitals sometimes and they’ll have two ventilators and now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’” Fox News and The Wall Street Journal share common ownership.

President Trump said Friday he still thought there was a “very good chance” the country wouldn’t need that many ventilators, but that the U.S. could send any leftover ventilators to other countries.

Following mounting pleas from governors and health-care workers to invoke the Defense Production Act to force U.S. companies to make needed gear, the president on Friday used the law to direct General Motors Co. to “accept, perform and prioritize federal contracts for ventilators.”

The White House didn’t respond to a request for comment. Earlier this week, the Federal Emergency Management Agency shipped 4,000 ventilators to New York, Vice President Mike Pence said.

In a briefing Friday, President Trump acknowledged that “ventilators are a big deal.”

“Oftentimes you don’t need ventilators very much, hospitals don’t have very many,” he said. “And now we’re turning out that we have to produce large numbers, but we’ve been able to do that and we’re going to be doing a lot more.”

He pointed to his decision to invoke the Defense Production Act to compel GM to produce ventilators, but said of his use of the law “we might be able to pull it” now that the administration had come to an agreement with the company.

Meanwhile, doctors at New York’s Columbia University Irving Medical Center this week put more than one patient on the same ventilator, a spokeswoman confirmed. They held a conference call on Friday with other doctors to share their own protocol for how to put two patients on one ventilator.

After attending the Wednesday meeting in Washington, Dr. Charlene Irvin Babcock raced back to Ascension St. John Hospital in Detroit to create a video to brief doctors nationwide on the group’s protocol. She says she didn’t have a standard ventilator available for her demonstration because all at her hospital are in use. She said they have “disposable” ventilators, which last for 30 days, as backups.

Dr. Irvin Babcock was sending her video back to Washington on Friday. An HHS spokeswoman didn’t immediately respond to a request for comment.

“I want to credit Washington for looking at all possible scenarios,” said Dr. Irvin Babcock. “We don’t know what’s going to happen but we want to be prepared.” She said the group was also preparing a white paper describing their protocol.

Dr. Irvin Babcock and Dr. Greg Neyman, of Toms River Community Medical Center in New Jersey, first envisioned the idea of splitting ventilators in a 2006 paper. Until this week, the only documented case of it being tried was after the mass shooting in Las Vegas in 2017.

That case was simpler: The patients needed to be stabilized only for short periods before surgery. And they didn’t have sick lungs, which meant two patients of roughly the same size could breathe effectively at a single air-pressure setting.

Covid patients sometimes need breathing support for weeks, further straining ventilator supplies. And the disease attacks the lungs—which means sicker patients may need higher air pressure from a ventilator to help them breathe. Hooking up a sicker patient with a relatively healthier one could complicate getting the right amount of air to both.

The protocol worked out in Washington is partly an effort to determine how to best match patients. Even so, sharing the machines is an absolute last resort. Doctors can end up with a game of “musical ventilators,” Dr. Neyman said.

Some have no choice. Dr. Marco Garrone, an emergency physician in Italy, tweeted a photo last week of two patients connected to the same ventilator. Today he followed up with another tweet showing the doctors are still doing it. “This is just EXPERIMENTAL. No evidence, just doing things out of necessity. Difficult to track the results,” he tweeted.-Wall Street Journal

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