Critical illness Malaria & Critical illness

The CCAA collaboration strengthens existing healthcare system capacity for continual data driven care quality evaluation and stakeholder-led quality improvement activities focused on improving outcomes and experiences for patients, their families and healthcare providers. CCAA also seeks to improve equitable opportunities for stakeholders to engage in discovering new evidence for treatments to improve outcomes during and following critical illness. At the core of the CCAA is a data platform (the CCAA registry) that facilitates near real-time data capture, clinical audit and feedback, and enables embedded trials for acute and critical care. The platform is managed and curated by NICS-MORU, a Sri Lanka based non-profit research unit, and a collaborating partner of MORU.

All participating ICUs in the network have implemented a basic electronic registry, contributing to an expanding dataset comprising epidemiological and quality of care parameters (e.g. PRICE ICU registry in Pakistan and IRIS registry in India). The quantitative analysis using the registry has been supplemented with qualitative evaluations of the quality of care in ICUs in Bangladesh and India. These will feed into locally led quality improvement activities.

CCAA collaborating centres are now leading on and participating in registry enabled multi-centre clinical trials for critical care management, including:

• REMAP-CAP (an adaptive platform trial evaluating interventions in severe pneumonia caused by COVID-19 as well as other pathogens);
• MegaROX ( a platform trial evaluating peripheral blood oxygen saturation targets in mechanically ventilated patients); and
• ARISE (Adult Respiratory Intervention Study Evaluation), in 11 ICUs in Uganda, determining whether high-flow nasal oxygen (HFNO) or continuous positive airway pressure (CPAP) systems can reduce mortality among patients with acute respiratory failure compared with standard low flow oxygen therapy.

A number of locally led clinical studies have been initiated in CCAA, such as home care for patients with a tracheostomy and the impact of frailty on ICU outcomes. A new study on the use of procalcitonin for de-escalating antibiotic usage in patients with suspected sepsis (PROCALBAN) will start recruiting at Chattogram Medical College Hospital in Bangladesh in 2023. CCAA will also support the PEGASUS trial in several Bangladesh sites, exploring the use of lung ultrasound for personalization of mechanical ventilation settings in patients with acute respiratory distress syndrome.

CCAA is a collaborator of LOGIC, an international quality improvement consortium of ICU registries spanning four continents. View aggregated LOGIC data.

For further information about the trials and sites, please contact Luigi Pisani or Rashan Haniffa.

For queries regarding the CCAA data platform, data access and management, and software development, kindly contact Abi Beane or info@nicslk.com.

Current critical illness research topics include:

• Implementation of an electronic registry in the ICU network, to facilitate high quality clinical research, care improvement, infectious disease surveillance and service forecasting.
• Health systems research combining stakeholder led mixed methods evaluations of care delivery, care organisation and outcomes which feed into quality improvement interventions.
• Large multicentre trials, covering studies on lung-protective mechanical ventilation, Oxygen management, Infectious disease management including severe acute respiratory infections.
• Piloting novel low cost monitoring and imaging techniques in collaboration with OUCRU