The COVID-19 Pandemic’s Impact on Critical Care Resources and Providers: A Global Survey

Wahlster, Sarah; Sharma, Monisha; Lewis, Ariane K.; Patel, Pratik V.; Hartog, Christiane; Jannotta, Gemi; Blissitt, Patricia; Kross, Erin K.; Kassebaum, Nicholas J.; Greer, David M.; Curtis, J. Randall; Creutzfeldt, Claire J.

Background The COVID-19 pandemic has severely impacted Intensive Care Units (ICUs) and Critical Care Healthcare Providers (HCPs) worldwide. Research Question How do regional differences and perceived lack of ICU resources affect critical care resource utilization and the well-being of HCPs? Study Design and Methods Between April 23rd-May 7th 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for critically ill COVID-19 patients. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated by World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: 1) Limiting mechanical ventilation (MV), 2) changes in cardiopulmonary resuscitation (CPR) practices, and 3) emotional distress or burnout. Results We included 2700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (10%) and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for COVID-19 patients was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (aRR:2.10, 95% CI:1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America), and associated with female gender (aRR:1.16, 95% CI:1.01-1.33), being a nurse (aRR:1.31, 95% CI:1.13-1.53), reporting a shortage of ICU nurses (aRR:1.18, 95% CI:1.05-1.33) and powered air-purifying respirators (PAPRs) (aRR:1.30 95% CI:1.09-1.55), as well as experiencing poor communication from supervisors (aRR:1.30, 95% CI:1.16-1.46). Interpretation Our findings demonstrate variability in ICU resource availability and utilization worldwide. The high prevalence of provider burnout, and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.