Table 1:

Detailed exclusion criteria

CriteriaCritical care triage stage 1Critical care triage stage 2Critical care triage stages 3 and 4
Patient preferenceAs documented by goals-of-care and advance care planning discussions
  • As documented by goals-of-care and advance care planning discussions

As documented by goals-of-care and advance care planning discussions
Past medical historyClinician judgment; must be mutually agreed upon by patient and clinician
  • End-stage organ failure*

    • Heart failure NYHA class IV

    • Lung disease

      • COPD with FEV1 < 30% predicted or baseline Pao2 < 55 mm Hg, or secondary pulmonary hypertension

      • Cystic fibrosis with postbronchodilator FEV1 < 30% predicted or baseline Pao2 < 55 mm Hg

      • Pulmonary fibrosis with VC or TLC < 60% predicted, baseline Pao2 < 55 mm Hg or secondary pulmonary hypertension

      • Primary pulmonary hypertension with NYHA class IV symptoms

    • Cirrhosis with MELD > 20

  • Metastatic malignant disease with expected survival of < 6 mo

  • Advanced and irreversible immunocompromise

  • Severe, irreversible and terminal neurologic event or condition (end-stage dementia)

  • Advanced untreatable neurodegenerative disease (Parkinson disease, ALS)

  • End-stage organ failure*

    • Heart failure NYHA class III or IV

    • Lung disease

      • COPD with FEV1 < 30% predicted or baseline Pao2 < 55 mm Hg, or secondary pulmonary hypertension

      • Cystic fibrosis with postbronchodilator FEV1 < 30% predicted or baseline Pao2 < 55 mm Hg

      • Pulmonary fibrosis with VC or TLC < 60% predicted, baseline Pao2 < 55 mm Hg or secondary pulmonary hypertension

      • Primary pulmonary hypertension with NYHA class IV symptoms

    • Cirrhosis with MELD > 20

Severity of presenting illnessClinician judgment; must be mutually agreed upon by patient and clinician
  • Age > 80 yr and cardiac arrest with 1 of the following poor prognostic factors:

    • Unwitnessed cardiac arrest

    • Any PEA arrest

    • Recurrent cardiac arrest

  • Cardiac arrest, regardless of age, with 1 of the following poor prognostic factors:

    • Unwitnessed cardiac arrest

    • Any PEA arrest

    • Recurrent cardiac arrest

  • Severe trauma or burns

    • Trauma with ISS > 16, unless determined to be acutely reversible

    • Burns with 2 of the following:

      • Age > 60 yr, > 40% BSA, inhalational injury

    • Severe neurologic injury

      • TBI meeting all of the following criteria:

      • Age > 60 yr, GCS < 8, and 1 or both unreactive pupils

    • SAH with WFNS grade V

    • CVA

      • Age > 70 yr with large MCA territory CVA, substantial deficits, not amenable to reperfusion

    • Posterior circulation stroke with GCS < 8

Age and Clinical Frailty ScoreClinician judgment; must be mutually agreed upon by patient and clinicianClinician judgment; must be mutually agreed upon by patient and clinician
  • Age > 80 yr and

  • Clinical Frailty Score ≥ 5

  • Note: ALS = amyotrophic lateral sclerosis, BSA = body surface area, COPD = chronic obstructive pulmonary disease, CVA = cerebrovascular accident, FEV1 = forced expiratory volume in 1 minute, GCS = Glasgow Coma Scale, ICU = intensive care unit, ISS = Injury Severity Score, MCA = middle cerebral artery, MELD = Model for End-Stage Liver Disease, NYHA = New York Heart Association, PEA = pulseless electrical activity, SAH = subarachnoid hemorrhage, TBI = traumatic brain injury, TLC = total lung capacity, VC = vital capacity, WFNS = World Federation of Neurosurgical Societies.

  • * If the patient is currently on a waiting list for organ transplant and admission to the ICU would place them at the top of the waiting list, an exception should be made and the patient should be admitted to the ICU. However, if organ donation programs are put on hold because of the pandemic, this exception is no longer valid.

  • If the patient’s most responsible physician determines the cause of the cardiac arrest to be acutely reversible, the patient is not excluded from ICU care.