CCU038: Evaluating the impact of COVID-19 on critical care outcomes

Project lead:
Chris Tomlinson, UCL

Despite advances in modern medicine, a significant proportion of those admitted to intensive care will unfortunately not survive. The reasons why certain patients do better or worse are complex and remain poorly understood, but include the interplay between a patient’s underlying health conditions, including cardiovascular disease, and their current illness. The emergence of the COVID-19 pandemic created unprecedented critical care demand to provide breathing support (ventilation) to the sickest patients. As a new disease, this added to the uncertainty whilst highlighting the need to better understand individual’s risk. Furthermore, the volume of cases also disrupted usual admissions to intensive care units (ICU), such as after cardiac surgery, and is likely to have changed risks for these patients too.

By identifying all patients receiving ventilation, or admitted to ICU, during their COVID-19 hospital admission and studying their demographics and cardiovascular comorbidities, risk factors and medication, we will explore which factors are associated with a patient’s risk of adverse outcomes, such as death or needing organ support. We will compare this with pre-pandemic ICU admissions to see whether some of these risks could have been foreseen using historical data. Comparing all patients admitted to ICU during COVID-19 with pre-pandemic years will reveal the extent to which the pandemic has impacted other ICU admissions not related to the virus.

Better understanding of an individual’s risk of adverse outcomes when admitted to ICU, such as with COVID-19, has multiple important implications. At an individual level such information may allow patients, and their treating clinicians, to better understand the risks they personally face, facilitating better informed treatment discussions. At trust and national levels, and in combination with understanding the disruption to pre-pandemic care, we aim to provide evidence of the demand for critical care services, and whether when this is stretched it affects outcomes, with important implications including future pandemic preparedness and addressing the backlog of medically important, but non-urgent surgery.