ICU care ‘limited to those likelier to survive’

INTENSIVE care for coronavirus patients is now being limited to those “reasonably certain” to survive, Imperial College Healthcare has conceded.

A department head said last night that fewer marginal patients were being selected for ventilator treatment because so many serious cases require a fortnight on the machines.

It comes as the NHS faces the toughest week in its history, with Dr Jenny Harries, the Deputy Chief Medical Officer, warning yesterday that deaths will rise. Imperial acknowledged that “very poorly patients with coronavirus may need to be on a ventilator for extended periods”, adding that “for some patients, this would not be in their best interests”, but denied people are being denied care due to capacity problems.

It amounts to the first admission that NHS doctors have significantly tightened their intensive care admission criteria since the start of the outbreak.

It follows a study by the Intensive Care National Audit and Research Centre (ICNARC), which found that the death rate for Covid-19 patients admitted to intensive care units is nearly 50 per cent. Comprising two large acute hospitals in west London, Imperial is so far coping with the flow of patients, unlike several others in the capital.

However, the senior consultant told The Daily Telegraph: “As we learn more about the disease, we are being much more careful about which patients are being considered for critical care.

“In normal times we will give most people the benefit of the doubt. That has changed. With this infection, you need a couple of weeks on a ventilator, so with resources being used for such a long time, you have to be reasonably

certain the person is going to get better. Delaying their death for two or three weeks is not the right thing for them or for society.”

The disclosure follows advice from palliative care doctors in recent days that family members should ask elderly loved ones if they want hospital treatment should they get infected.

Rachel Clarke, a specialist in Oxford, warned that Covid-19 patients were spending their final hours and days alone in ICUS.

During Any Answers on BBC Radio 4 on Saturday, Anita Anand, the presenter, described the calls she received to discuss quality of death with coronavirus as “breaking my heart”.

The ICNARC study involved 165 patients treated in critical care in England, Wales and Northern Ireland. Seventy-nine died, while 86 survived.

The sample was taken from a wider audit of 775 people who have been or are in critical care, 610 of whom continue to receive intensive care.

Although Imperial denies that it has or will need to ration critical care due to capacity issues, front-line staff at other London trusts have told The Telegraph that this is already happening at their hospitals. The NHS says it has access to around 8,000 ventilators, and the Government is desperately trying to source another 30,000.

The National Institute of Health and Care Excellence (Nice) has issued a framework instructing doctors to prioritise those most likely to survive.

Health officials have so far preferred to talk instead about guidelines enabling doctors to have “difficult conversations” with families. However, Nice’s Dr Paul Chrisp, said that the framework

enables doctors to ration scarce ventilators to patients with the best chance.

An NHS spokesman said: “There are hundreds of critical care beds available in London and thousands across the rest of the country so any patient that would benefit can get the care they need.”