Because of the unprecedented demand on hospital and ICU resources during the COVID-19 (SARS CoV-2) pandemic, many hospitals may be challenged with providing mechanical ventilation to all those in need of this therapy. The U.S. Department of Health and Human Services (HHS) and the Federal Emergency Management Agency (FEMA) are working with multiple partners that include healthcare systems, academic institutions, professional medical societies, and the National Academies of Science, Engineering and Medicine to develop crisis standards of care strategies for ventilator support when resources are limited.

To meet the growing demand for mechanical ventilators, the HHS Assistant Secretary for Health and U.S. Surgeon General issued an open letter to the healthcare community stressing the need to aggressively implement the following four measures:

Rigorous adherence to all social distancing measures, including limitations on gatherings and travel. This is the best way to reduce infections and thus demand for ventilators. Following guidelines to optimize the use of mechanical ventilators. This includes canceling elective surgeries, using equipment from state regions not experiencing outbreaks, as well as transition of anesthesia machines and other respiratory devices for use as mechanical support for those in respiratory failure from COVID-19 and other diseases. Judicious, data driven requests and usage of the Strategic National Stockpile (SNS) of ventilators and equipment. To be able to allocate ventilators where they are most needed, all states must be data-driven in their requests based on the actual capacity for mechanical ventilation, including anesthesia machine conversions. Increasing the capacity of the SNS through federal procurement. The SNS will receive at least an additional 20,000 mechanical ventilators by mid-May 2020.

In addition, a possible crisis standard-of-care strategy, currently contemplated by several centers, is using one ventilator for two patients. Co-venting should only be considered as an absolute last resort and for a limited amount of time.

“According to our best projections, combined with information on the ground, the availability of precious medical resources will be limited in some places because of the numbers of patients and their severity of illness,” said Assistant Secretary for Health, ADM Brett P. Giroir. “We want our healthcare heroes on the frontlines to be armed with the broadest possible range of ventilator support strategies to aid in the decisions that must be made at the individual institution, care-provider, and patient levels during the current time of limited resources and evolving standards of care.”

You may find the open letter and other resources: https://www.hhs.gov/about/news/coronavirus/optimizing-ventilator-use-during-covid19-pandemic.html.