SMH – St. Michael’s Hospital Medical Services Organization
SMH-20-040 – Developing and implementing a Toronto Critical Care Research Hub (TCCRH) for conducting pandemic research to allow efficient and effective conduct for completion of pandemic research in critical care.
Aim- To rapidly and efficiently establish a novel COVID focussed clinical research hub to allow the design, conduct and timely completion of high-quality pandemic research in the Critical Care Units of Toronto that will save lives during the course of this pandemic. REMAP-CAP- Is a global platform trial, designed to accelerate clinical research during pandemics, and currently recruiting patients with COVID-19 from 314 sites around the world. In Canada, we are funded through a CIHR grant and have recruited 370 patients from 34 active sites . AFP hub funding has been crucial for the recruitment of new sites for the trial. REMAP-CAP is generating real time evidence about the value of differing treatment options for COVID-19, and changing practice in the management of the sickest patients around the world. It is sharing data with the WHO and contributing to meta-analyses of the efficacy of numerous treatments, whilst being incorporated into clinical practice guidelines. CAT-CO RCT- CAT-CO is an adaptive trial looking at a variety of treatments in COVID-19 led by key members of our collaboration. It has recruited 1478 patients to date and will continue this until the pandemic is over. LOVIT RCT- Is an RCT of vitamin C in COVID-19 and has now completed recruitment and is under analysis at this time. This RCT will identify the place of Vitamin C in COVID disease and supply vitally important results for practice. ANACONDA (SAVE-ICU) study- Was developed at the start of the pandemic and tests whether volatile inhaled anesthesia agents offers better sedation to existing models of care. The RCT was developed at the time of a great shortage at the early stages of the pandemic using hub funding and went on to gain peer reviewed funding from CIHR ($3M) and the Government of Ontario ($1.3M). Recruitment is ongoing for this trial. Decision-model- Aimed to develop a competency-based ICU staffing model for non-ICU physicians in Ontario. Both COVID-specific (treatment, ventilation) and generic ICU topics (best practices, antibiotics) were identified as learning needs. From this we revised the competency frameworks used by different specialty training programs to identify overlap in targeted competencies. Our work has revised the pandemic staffing model proposed by the Ontario Provincial Work Group. Pandemic triage model- The pandemic led to the potential need for triage of patients for allocation of scarce resources, such as ventilators without knowledge of the implications when applied to patients. This work systematically examined the impact of applying specific criteria from two sets of allocation frameworks to a non-COVID population of ICU patients. We applied specific triage criteria from 2 guidelines to assess the patients identified as lowest priority for ventilation in the setting of a ventilator shortage. Of 40,439 admissions, 9% would likely meet criteria for the lowest priority for ventilator allocation compared with 4% using a framework that considered saving lives and life-years. Only 1.6% were in the lowest priority category for both guidelines, with 39% survival to hospital discharge for admissions identified as lowest priority compared with 56% for admissions identified using the other criteria. Clinical registry evaluation- The iCORE project is a high-quality prospective registry of critically ill patients in 9 hospitals to measure adherence to best practices, provide data on processes of care to inform quality improvement. We designed and implemented a new COVID-19 data module in iCORE to collect more granular information on the characteristics and resource utilization and complications of COVID-19 patients admitted to the ICU receiving mechanical ventilation.
Prevention and Treatment
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