Nine months after Discovery, the Critical Care Research Network, launched the Viral Infection and Respiratory Illness Universal Study (
VIRUS), the first global COVID-19 registry to track ICU and hospital care patterns in near real-time, researchers have identified sizable variations in practice and outcomes among hospitals, prompting action to unearth the causes and inform improved and equitable care. A partnership between SCCM and Mayo Clinic, VIRUS continues to grow and is launching the Structured Team-Based Optimal Patient-Centered Care for Virus COVID-19 (
STOP-VIRUS) ICU Learning Collaborative. The collaborative aims to turn key learnings into specific recommendations to ensure that ICUs are better prepared for the ongoing pandemic as well as future viral pandemics.
Recognizing the value in gathering consensus data during a pandemic (in light of the lack of such timely information during the Ebola outbreak) VIRUS was launched in May 2020 and has grown to include over 65,000 adult and pediatric hospital admissions at 297 sites in 25 countries and more than 1000 pediatric hospital admissions at 69 sites in nine countries and continues to welcome new sites.
Learn more about the registry and how to join.
The key finding that has emerged from the registry is the sizable variation in practice and outcomes that cannot be explained by patient characteristics, with hospital mortality ranging from 20% to 80% among hospitals. “Because there is no definitive treatment for COVID-19 as of now, our focus is to learn from high-performing hospitals’ practice and disseminate those findings to all,” said Rahul Kashyap, MD, MBBS, MBA, Mayo Clinic researcher and principal investigator of the VIRUS COVID-19 Registry. “That led us to partner with the Centers for Disease Control and Prevention (CDC) for support to convey key learnings based on experiential observations.”
STOP-VIRUS
This is where the STOP-VIRUS ICU Learning Collaborative comes in. Via a cooperative agreement, the CDC provided funding for new content for SCCM’s online Rapid Resource Center, critical care support programs for clinicians who are not critical care professionals, and collaborative activity.
STOP-VIRUS consists of two parts. In the first part, the collaborative is inviting sites at various stages of implementation to participate and share what they have tried and what has and has not worked in caring for critically ill patients. The second part involves a series of qualitative interviews with the participating sites to ascertain which practice variations have translated into patient care.
“STOP-VIRUS is an important first step in understanding the drivers of practice variation, as well as evaluating the effects of simple quality improvement interventions on outcome disparities in COVID-19,” said Allan J. Walkey, MD, MS, Boston University Medical Center researcher and co-principal investigator.
The benefits of participation include access to Mayo Clinic’s online
CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and Injury) Programs for instruction, collaborative learning, and weekly discussions and multiprofessional peer coaching to help improve adherence to best practices.
The collaborative is accepting applications from sites in the United States and its territories. All sites must be participating in VIRUS, have at least three months of data from 2020, and feature a multiprofessional team with a critical care physician, nurse, pharmacy leader, and respiratory therapist. The goal is to include 15 adult ICUs and 5 pediatric ICUs. The collaborative plans to conclude at the end of September 2021.
Learn how to apply.
VIRUS
The first outcomes of VIRUS were
published in January 2021 in
Critical Care Medicine. More than 20 manuscripts are being prepared for publication during the next several months. Additionally, sites have been invited to submit ancillary study ideas drawing on registry data. Of the 150 proposed, more than 60 have been approved.
“We are working to bring results on practice variations to the scientific community as soon as they become available,” said Vishakha Kumar, MD, MBA, co-principal investigator and associate director of research for Discovery at SCCM. “There is a need to design and study novel medications based on data generated from the registry, and we welcome new sites to join, contribute their data, and be part of this important effort.”
Current VIRUS COVID-19 Registry dashboard findings among 64,182 adult hospital admissions and 12,130 adult ICU admissions include:
- Mechanical ventilation 28%
- Noninvasive ventilation 13%
- High-flow nasal oxygen 19%
- Dialysis 10%
- Extracorporeal membrane oxygenation 2%
The median ICU length of stay was seven days, and 83% were discharged alive from the hospital. The top reported comorbidities are:
- Hypertension 59%
- Diabetes 37%
- Obesity 20%
- Chronic kidney disease 15%
- Coronary artery disease 14%
In the pediatric group, findings among 1124 hospital admissions and 431 ICU admissions are:
- Mechanical ventilation 12%
- Noninvasive ventilation 9%
- High-flow nasal oxygen 14%
- Dialysis 1%
- Extracorporeal membrane oxygenation 1%
Median ICU stay was 4 days, and 97% were discharged alive from the hospital. The top comorbidities include:
- Asthma 28%
- Seizures or epilepsy 17%
- Obesity 15%
- Developmental delay 15%
- Diabetes 7%
- Static encephalopathy 5%
- Chronic lung disease 4%
Nearly one-third (29%) had multisystem inflammatory syndrome in children (MIS-C).
Learn more about overall outcomes.
VIRUS is collaborating with a variety of entities to coordinate findings and disseminate key learning. In addition to the
CDC, these include the
American College of Radiology, the
American Heart Association, the
International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC),
PointClickCare, and the
U.S. Food and Drug Administration through collaboration with
CURE ID.
The VIRUS COVID-19 Registry will remain open until at least April 2022 and may be extended.
