The effect of COVID-19 on critical care research during the first year of the pandemic: A prospective longitudinal multinational survey

Importance

The COVID-19 pandemic has increased the need for high-quality evidence in critical care, while also increasing the barriers to conducting the research needed to produce such evidence.

Objective

To determine the effect of the first wave of the COVID-19 pandemic on critical care clinical research.

Design

Monthly electronic survey (March 2020 - February 2021).

Setting

Adult or pediatric intensive care units (ICUs) from any country participating in at least one research study before the COVID-19 pandemic.

Participants

We recruited one researcher or research coordinator per center, identified via established research networks.

Intervention(s)

None

Main Outcome(s) and Measure(s)

Primary: Suspending recruitment in clinical research; Secondary: impact of specific factors on research conduct (5-point scales from no effect to very large effect). We assessed the association between research continuity and month, presence of hospitalized patients with COVID-19, and population (pediatric vs. adult ICU) using mixed-effects logistic regression.

Results

127 centers (57% pediatric) from 23 countries participated. 95 (75%) of centers suspended recruitment in at least some studies and 37 (29%) suspended recruitment in all studies on at least one month. The proportion of centers reporting recruitment in all studies increased over time (OR per month 1.3, 95% CI 1.2 to 1.4, p < 0.001), controlling for hospitalized patients with COVID-19 and type of ICU (pediatric vs. other). The five factors most frequently identified as having a large or very large effect on clinical research were: local prioritization of COVID-19 specific research (68, 54%), infection control policies limiting access to patients with COVID-19 (61, 49%), infection control policies limiting access to the ICU (52, 41.6%), increased workload of clinical staff (38, 30%), and safety concerns of research staff (36, 29%).

Conclusions and Relevance

Decisions to pause or pursue clinical research varied across centers. Research activity increased over time, despite the presence of hospitalized patients with COVID-19. Guiding principles with local adaptation to safely sustain research during this and future pandemics are urgently needed.

Key Points