sprint sari (aust) management committee sphpm - sprint

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Data in this report should not be reproduced

without permission.

When reading please be aware of data limitations

on Page 2.

Sprint Sari (Aust) Management committee

SPHPM - Sprint Sari Study

[email protected]

mailto:[email protected]

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SPRINT-SARI

AUS Report on COVID-19 Admissions to the Intensive Care Unit

in Australia

Summary Report

February, 2020 - December, 2021

The results in this report have been produced using data from the SPRINT-SARI AUS ICU COVID-19 database, Monash

University. For further information or to contribute to this project, please contact [email protected].

We would like to thank all the research coordinators and data collectors across Australia for providing this data

during the ongoing pandemic. This report of aggregate data will be issued every two to four weeks for the duration

of the COVID-19 pandemic.

Data in this report was extracted on 07 December 2021 at 16:24h and pertains to ICU admissions in Australia

reported to the SPRINT-SARI AUS ICU COVID-19 database until 07 December 2021. At total of 2864 patients of all

ages have now had their data entered, from 64 sites across 6 states and 2 territories. Overall, 2684 individuals were

PCR-positive for COVID-19.

Patients were initially entered into the database if they were COVID-19 positive on PCR test, or suspected of being

positive at the time of the report. However, after July 01, 2020, patients were only entered if they were PCR positive.

Phase 1 was defined as any admission before 01 July 2020, phase 2 is from 01 July 2020 until 25 June 2021, and

phase 3 after 25 June 2021.

The utmost effort has been made to ensure the highest quality data is being reported. However please note the

following caveats:

• The population in this report reflect the sickest patients with COVID-19 infection being managed in the ICU,

and do not reflect the overall population of COVID-19 positive patients.

• Information is not complete for all patients.

• Whenever possible, transfers were aggregated into one record.

• As the pandemic is ongoing and site contributions evolve, it is possible for trends and distributions to change

as more data is collected with greater precision. This report is also descriptive and we urge caution in any

inference particularly around causation.

• Due to an extreme workload site staff are not always available to enter data. Site staff make best efforts to

collect all data, but we estimate that 189 patients have not been included for this period.

• Not all sites have governance approval to enter data. We estimate that 270 patients are not included.

• We stopped collecting data on certain points since September 2021.

For further information

Please contact

Dr Aidan Burrell - [email protected]

Prof Andrew Udy - [email protected]

Ms Tessa Broadley - [email protected]

Australian and New Zealand Intensive Care Research Centre





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Summary

As of 07 December, 2021, a total of 79 ICU sites were participating in the SPRINT-SARI COVID-19 database, and 64

ICU sites contributed data. A total of 2864 ICU COVID-19 admissions were reported to SPRINT-SARI in the period.

Considering PCR-positive patients, 2684 COVID-19 admissions were reported to SPRINT-SARI. Table 1 provides a

breakdown by State and Territory.

Table 1. Overview by State/Territory – Participation and Admissions

Number of ICU Sites Number of ICU Admissions

State / Territory

Participating Contributing Data

Confirmed COVID-19

Suspected* COVID-19

(Negative swab)

Suspected* COVID-19

(Awaiting swab)

Managed* as COVID-19

(Negative swab)

NSW 15 15 1270 6 9 9

VIC 28 24 1275 8 62 6

QLD 17 12 34 2 3 0

WA 9 7 37 5 3 0

SA 5 2 25 0 1 0

TAS 2 2 2 1 2 0

NT 2 1 4 0 0 0

ACT 1 1 37 0 0 0

Total 79 64 2684 22 80 15 Notes: *ICU admissions with strong clinical suspicion of COVID-19 (with negative swab or awaiting swab) are managed as

COVID-19.

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Number of ICU admissions

The daily number of ICU beds occupied by COVID-19 patients are shown in Figure 1 and a State/Territory breakdown

of admissions is presented in Figure 2.

Figure 1. Daily number of ICU beds occupied by patients with

confirmed or strong clinical suspicion of COVID-19

Figure 2. Cumulative number of ICU admissions with confirmed or

strong clinical suspicion of COVID-19 by State and Territory

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Figure 3. Daily Percentage of Bed Occupancy by COVID-19 Patients in the Centres Contributing Data

The daily bed occupancy refers to the number of beds occupied by COVID-19 patients in the ICUs contributing data to the study, and not to the overall number of beds in Australia.

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Figure 4. Daily Intensity of Bed Occupancy by COVID-19 Patients in the Centres Contributing Data

The daily bed occupancy refers to the number of beds occupied by COVID-19 patients in the ICUs contributing data to the study, and not to the overall number of beds in Australia. X-axis shows

the days since the beginning of the pandemic, Y-axis shows the centres ordered and clustered within the state (left box), and each small cell represents the occupancy in the specific centre on the

specific day. Green is lower occupancy and red is higher occupancy. Number of beds are from pre-pandemic period and were not updated after the expansion due to COVID-19.

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Demographics

Patient characteristics of ICU admission with confirmed COVID-19 are provided in Table 2. This table, and the

remaining sections of this report will focus only on the confirmed COVID-19 admissions. Age and body mass index

(BMI) distributions by sex for confirmed COVID-19 admissions are also provided in Figures 3, 4 and 5.

Table 2. Characteristics of patients admitted to ICU with confirmed or managed as COVID-

19 According to the Phases

Confirmed COVID-19

Overall

(n = 2699)

Phase 1

(n = 217)

Phase 2

(n = 298)

Phase 3

(n = 2184)

p

value

Age at admission, median (IQR) 55 (42 - 66) 64 (53 - 72) 58 (48 - 68) 54 (41 - 65) < 0.001

Age group at admission, N (%) < 0.001

0-9 years 20 (0.7%) 2 (0.9%) 2 (0.7%) 16 (0.7%)

10-19 years 46 (1.7%) 2 (0.9%) 2 (0.7%) 42 (1.9%)

20-29 years 171 (6.4%) 3 (1.4%) 18 (6.0%) 150 (6.9%)

30-39 years 324 (12.1%) 16 (7.4%) 18 (6.0%) 290 (13.4%)

40-49 years 425 (15.9%) 22 (10.1%) 42 (14.1%) 361 (16.7%)

50-59 years 621 (23.2%) 38 (17.5%) 80 (26.8%) 503 (23.3%)

60-69 years 595 (22.2%) 59 (27.2%) 77 (25.8%) 459 (21.2%)

70-79 years 385 (14.4%) 63 (29.0%) 46 (15.4%) 276 (12.8%)

80-89 years 89 (3.3%) 12 (5.5%) 13 (4.4%) 64 (3.0%)

Sex, N (%) 0.135

Male 1648 (61.5%) 151 (69.6%) 185 (62.1%) 1312 (60.6%)

Female 1032 (38.5%) 66 (30.4%) 113 (37.9%) 853 (39.4%)

Variant of concern, N (%) < 0.001

None 1417 (52.5%) 217 (100.0%) 279 (93.6%) 921 (42.2%)

Alpha, B.1.1.7 (UK) 6 (0.2%) 0 (0.0%) 3 (1.0%) 3 (0.1%)

Beta, B.1.351 (South Africa) 1 (0.0%) 0 (0.0%) 1 (0.3%) 0 (0.0%)

Gamma, P.1 (Brazil) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%)

Delta, B.1.617.2 (India) 314 (11.6%) 0 (0.0%) 1 (0.3%) 313 (14.3%)

Other 6 (0.2%) 0 (0.0%) 1 (0.3%) 5 (0.2%)

Unknown 955 (35.4%) 0 (0.0%) 13 (4.4%) 942 (43.1%)

Received COVID-19 vaccine, N (%) 484 / 2394 (20.2%) 0 / 217 (0.0%) 1 / 291 (0.3%) 483 / 1886 (25.6%) < 0.001

How many doses, N (%) < 0.001

1 366 / 2394 (15.3%) --- 1 / 291 (0.3%) 365 / 1886 (19.4%)

2 117 / 2394 (4.9%) --- 0 / 291 (0.0%) 117 / 1886 (6.2%)

3 1 / 2394 (0.0%) --- 0 / 291 (0.0%) 1 / 1886 (0.1%)

Time since last dose, N (%) ---

Within 7 days 59 / 340 (17.4%) --- --- 59 / 340 (17.4%)

7 - 14 days 92 / 340 (27.1%) --- --- 92 / 340 (27.1%)

More than 14 days 189 / 340 (55.6%) --- --- 189 / 340 (55.6%)

Type, N (%) ---

Pfizer/BioNTech 234 / 468 (50.0%) --- 0 / 1 (0.0%) 234 / 467 (50.1%)

Oxford AstraZeneca 217 / 468 (46.4%) --- 1 / 1 (100.0%) 216 / 467 (46.3%)

Novavax 0 / 468 (0.0%) --- 0 / 1 (0.0%) 0 / 467 (0.0%)

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Confirmed COVID-19

Overall

(n = 2699)

Phase 1

(n = 217)

Phase 2

(n = 298)

Phase 3

(n = 2184)

p

value

Moderna 9 / 468 (1.9%) --- 0 / 1 (0.0%) 9 / 467 (1.9%)

Other 8 / 468 (1.7%) --- 0 / 1 (0.0%) 8 / 467 (1.7%)

Pregnant, N (%) 67 / 993 (6.7%) 0 / 62 (0.0%) 1 / 109 (0.9%) 66 / 822 (8.0%) 0.002

Gestational weeks, median (IQR) 28.0 (23.8 - 33.2) --- 26.0 (26.0 - 26.0) 28.0 (23.5 - 33.5) 0.745

Indigenous, N (%) 32 (1.2%) 0 (0.0%) 1 (0.3%) 31 (1.4%) 0.065

Healthcare worker, N (%) 55 (4.3%) 16 (7.8%) 28 (10.1%) 11 (1.4%) < 0.001

Admitted from nursing home / aged care

hostel, N (%) 6 (0.5%) 1 (0.6%) 5 (1.8%) 0 (0.0%) 0.001

APACHE-II on day 1, median (IQR) 13 (9 - 17) 14 (10 - 18) 13 (9 - 17) 13 (9 - 16) 0.072

Corrected* 10 (7 - 14) 10 (6 - 14) 10 (7 - 14) 10 (7 - 14) 0.914

BMI at admission, median (IQR) 30.9 (26.3 - 36.4) 28.7 (24.4 - 32.2) 30.5 (26.4 - 35.4) 31.2 (26.6 - 37.3) < 0.001

BMI group, N (%) < 0.001

Underweight 15 (0.6%) 4 (1.8%) 2 (0.7%) 9 (0.4%)

Normal weight 304 (11.3%) 57 (26.3%) 38 (12.8%) 209 (9.6%)

Overweight 533 (19.7%) 56 (25.8%) 78 (26.2%) 399 (18.3%)

Obese - Class I 477 (17.7%) 48 (22.1%) 63 (21.1%) 366 (16.8%)

Obese - Class II 260 (9.6%) 23 (10.6%) 36 (12.1%) 201 (9.2%)

Obese - Class III 311 (11.5%) 14 (6.5%) 29 (9.7%) 268 (12.3%)

Not stated 799 (29.6%) 15 (6.9%) 52 (17.4%) 732 (33.5%)

Treatment, N (%)

Antibioticsa 776 (82.8%) 185 (91.1%) 245 (88.8%) 346 (75.5%) < 0.001

Steroids 1880 (88.6%) 61 (29.9%) 262 (92.9%) 1557 (95.2%) < 0.001

Tocilizumab 250 (9.3%) 0 (0.0%) 3 (1.0%) 247 (11.3%) < 0.001

Baricitinib 826 (30.6%) 0 (0.0%) 1 (0.3%) 825 (37.8%) < 0.001

Neutralizing antibodies 28 (1.0%) 0 (0.0%) 0 (0.0%) 28 (1.3%) 0.036

Remdesivir 976 (36.2%) 3 (1.4%) 155 (52.0%) 818 (37.5%) < 0.001

Inotrope and/or vasopressor 995 (46.4%) 118 (57.3%) 123 (44.7%) 754 (45.3%) 0.004

Non-invasive ventilation 760 (35.4%) 16 (7.7%) 41 (14.9%) 703 (42.2%) < 0.001

High-flow nasal cannula 1589 (73.4%) 88 (42.7%) 192 (68.8%) 1309 (77.9%) < 0.001

Invasive mechanical ventilation 1119 (50.1%) 126 (58.1%) 141 (49.1%) 852 (49.2%) 0.046

Neuromuscular blocking agentsb 373 (33.0%) 91 (44.4%) 91 (33.2%) 191 (29.2%) < 0.001

Prone positioning 1193 (55.4%) 58 (28.2%) 97 (35.1%) 1038 (62.2%) < 0.001

Awake prone positioning** 775 (34.8%) 12 (5.5%) 59 (20.8%) 704 (40.7%) < 0.001

Extracorporeal membrane oxygenation 100 (4.4%) 3 (1.4%) 13 (4.5%) 84 (4.7%) 0.078

Renal replacement therapy 162 (7.6%) 25 (12.1%) 22 (8.0%) 115 (6.9%) 0.028

Complications, N (%)

Viral pneumonitis 1756 (82.7%) 142 (70.3%) 150 (56.4%) 1464 (88.5%) < 0.001

Bacterial pneumonia 629 (31.0%) 45 (22.6%) 44 (17.1%) 540 (34.4%) < 0.001

Bacteraemia 185 (9.1%) 29 (14.6%) 24 (8.9%) 132 (8.5%) 0.019

Stroke / CVA 26 (1.3%) 3 (1.5%) 2 (0.7%) 21 (1.3%) 0.686

Cardiac arrhythmiac 189 (9.3%) 36 (17.8%) 33 (12.2%) 120 (7.7%) < 0.001

Barotraumad 110 (5.4%) 12 (5.9%) 11 (4.1%) 87 (5.6%) 0.579

Cardiac arrest 40 (2.0%) 4 (2.0%) 4 (1.5%) 32 (2.1%) 0.823

Pulmonary embolism 159 (7.9%) 7 (3.8%) 13 (4.9%) 139 (8.9%) 0.007

Deep vein thrombosis 81 (4.0%) 16 (8.6%) 11 (4.1%) 54 (3.5%) 0.003

Myocarditis 81 (4.0%) 24 (12.9%) 21 (7.8%) 36 (2.3%) < 0.001

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Confirmed COVID-19

Overall

(n = 2699)

Phase 1

(n = 217)

Phase 2

(n = 298)

Phase 3

(n = 2184)

p

value

PMIS 4 (0.5%) 0 (0.0%) 0 (0.0%) 4 (0.5%) 0.955

Notes: IQR is the interquartile range presented at the 25th and 75th percentiles. BMI is calculated for all aged 18 years and over.

PMIS is Paediatric Multisystem Inflammatory Syndrome.

* Removing the age component.

** Defined as at least one observation of prone positioning while not receiving invasive ventilation. a Not captured since September 2021. b Not captured since March 2021. c Requiring specific chemical/electrical therapy. d Pneumothorax or pneumomediastinum or subcutaneous emphysema on CXR/CT chest.

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Figure 5. Percentage of Admissions per Month According to Age Categories

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Figure 6. Age and sex distribution – Confirmed COVID-19

Figure 7. Age and mortality distribution – Confirmed COVID-19

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Figure 8. Variants over time

Figure 9. Hospital mortality according to vaccination status

Among patients who died, the percentage in each vaccination category is described in the graph. Only data from the third phase.

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Comorbidities

The prevalence of reported comorbidities for ICU admission with confirmed COVID-19.

Figure 10. Prevalence of comorbidities for admitted Confirmed

COVID-19 according to the phase

Figure 10.1. Prevalence of comorbidities reported for admitted

Confirmed COVID-19 according to the phase

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Figure 11. Distribution of common combinations of reported

comorbidities – Confirmed COVID-19

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Treatments

The treatments received by patients at any time during ICU admission for ICU admissions with confirmed COVID-19.

Figure 12. Treatment reported at any time during ICU admission

according to the phase – Confirmed COVID19

Figure 14. Distribution of combinations of the most common

treatments – Confirmed COVID-19

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Daily Follow-up

The SPRINT-SARI database records daily follow-up data for patients during their stay in ICU. The nursing-to-patient ratio for confirmed COVID-19 patients was 1:1 for 89.1% of

patients in ICU on any given day. The daily treatments received by confirmed COVID-19 patients during their stay in ICU are presented below.

Figure 15. Daily treatment while in ICU according to the phase – Confirmed COVID-19

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Figure 16. Daily use of prone positioning according to phase – Confirmed COVID-19

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Outcomes

Table 3. Patient outcomes according to the phase – Confirmed COVID-19*

Confirmed COVID-19

Phase 1 Phase 2 Phase 3

Overall

(n = 217)

Ventilated

(n = 126)

Not Ventilated

(n = 91)

Overall

(n = 298)

Ventilated

(n = 141)

Not Ventilated

(n = 146)

Overall

(n = 2183)

Ventilated

(n = 851)

Not Ventilated

(n = 879)

Length of ICU stay (days)*

Median (IQR) 9 (3 - 19) 16 (10 - 27) 3 (2 - 5) 6 (2 - 11) 11 (7 - 22) 3 (1 - 5) 6 (3 - 12) 13 (8 - 22) 3 (2 - 6)

Length of stay in hospital (days)*

Median (IQR) 18 (9 - 33) 26 (17 - 44) 9 (5 - 15) 14 (9 - 22) 20 (13 - 33) 10 (7 - 15) 13 (8 - 22) 19 (12 - 30) 10 (7 - 15)

Days of mechanical ventilation (days)**

Median (IQR) 12 (7 - 15) 12 (7 - 15) --- 8 (4 - 17) 8 (4 - 17) --- 10 (5 - 18) 10 (5 - 18) ---

Days of non-invasive ventilation (days)**

Median (IQR) 1 (1 - 2) 1 (1 - 2) 3 (2 - 4) 2 (1 - 3) 2 (1 - 3) 2 (1 - 4) 2 (1 - 4) 2 (1 - 3) 3 (1 - 5)

Days of ECMO (days)

Median (IQR) 8 (6 - 12) 8 (6 - 12) --- 12 (8 - 17) 12 (8 - 17) --- 16 (11 - 22) 16 (11 - 22) ---

Days of renal replacement therapy (days)

Median (IQR) 9 (4 - 10) 9 (5 - 10) 2 (2 - 2) 8 (5 - 13) 8 (5 - 13) 11 (11 - 11) 6 (3 - 12) 6 (3 - 12) 2 (1 - 2)

Patient status, N (%)

No. with hospital outcome** 210 (96.8%) 121 (96.0%) 89 (97.8%) 254 (85.2%) 130 (92.2%) 142 (97.3%) 1638 (75.0%) 632 (74.3%) 783 (89.1%)

Ongoing care in ICU 1 (0.5%) 0 (0.0%) 1 (1.1%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 269 (12.3%) 91 (10.7%) 36 (4.1%)

Ongoing care in hospital ward 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.3%) 0 (0.0%) 0 (0.0%) 149 (6.8%) 43 (5.1%) 29 (3.3%)

Transfer to other hospital/facility 6 (2.8%) 5 (4.0%) 1 (1.1%) 18 (6.1%) 10 (7.1%) 4 (2.7%) 125 (5.7%) 84 (9.9%) 30 (3.4%)

Transfer to rehabilitation 29 (13.4%) 27 (21.4%) 2 (2.2%) 24 (8.1%) 20 (14.3%) 4 (2.7%) 107 (4.9%) 79 (9.3%) 20 (2.3%)

Discharged home 151 (69.6%) 68 (54.0%) 83 (91.2%) 219 (73.7%) 81 (57.9%) 132 (90.4%) 1235 (56.6%) 356 (41.9%) 709 (80.8%)

Mortality - ICU 30 (13.8%) 26 (20.6%) 4 (4.4%) 30 (10.1%) 26 (18.6%) 4 (2.7%) 261 (12.0%) 193 (22.7%) 36 (4.1%)

Mortality - Hospital Ward 0 (0.0%) 0 (0.0%) 0 (0.0%) 5 (1.7%) 3 (2.1%) 2 (1.4%) 35 (1.6%) 4 (0.5%) 18 (2.1%)

Notes: This report includes data from 64 sites.

* ICU/hospital LOS is reported as the observed median time between ICU/hospital admission and discharge dates. The observed LOS is also only calculated for patients with both ICU/hospital admission and discharge dates recorded. IQR is the interquartile range presented as observed ICU/hospital LOS at the 25th and 75th percentiles.

** A patient with hospital outcome is defined as a patient classified as discharged home, transferred to rehabilitation or dead.

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Figure 17. Kaplan-Meier Curves of ICU Discharge

Patients who died before discharge were assigned the maximum follow-up time to account for the competing risk.

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Figure 18. APACHE II Risk of Death EWMA Chart – Confirmed COVID-19

This EWMA chart is based on the APACHE II risk of death model. It shows the weighted moving average of observed in-hospital mortality for COVID-19 patients admitted to ICU and the upper and lower limits of APACHE II predicted mortality. As

observed mortality increases the red line moves up; as mortality declines the red line moves down. If patients with greater severity of illness are admitted to the ICU the control lines for predicted mortality (blue) move up. Likewise, if less severely ill patients are admitted to the ICU the predicted mortality control lines move down. Ideally the red line of observed mortality should track within the APACHE II control lines.

APACHE II risk of death was calculated considering respiratory infection as the category of admission. Weight is assigned as 0.005 (as usual in ANZICS reports), and target (starting values) as 20% (usual mortality of invasive ventilated patients in Australia).

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Vaccination

Table 4. Characteristics of patients admitted to ICU with confirmed or managed as COVID-

19 According to Vaccination Status

Vaccinated*

(n = 484)

Not Vaccinated

(n = 1910) p value

Age at admission, median (IQR) 60 (47 - 69) 55 (41 - 65) < 0.001

Age group at admission, N (%) < 0.001

0-9 years 0 (0.0%) 19 (1.0%)

10-19 years 2 (0.4%) 37 (1.9%)

20-29 years 18 (3.8%) 123 (6.4%)

30-39 years 51 (10.6%) 236 (12.4%)

40-49 years 72 (15.0%) 304 (15.9%)

50-59 years 96 (20.0%) 463 (24.3%)

60-69 years 129 (26.9%) 410 (21.5%)

70-79 years 92 (19.2%) 257 (13.5%)

80-89 years 20 (4.2%) 59 (3.1%)

Sex, N (%) 0.039

Male 320 (66.5%) 1151 (60.3%)

Female 161 (33.5%) 757 (39.7%)

Variant of concern, N (%) < 0.001

None 185 (38.2%) 1005 (52.6%)

Alpha, B.1.1.7 (UK) 1 (0.2%) 3 (0.2%)

Beta, B.1.351 (South Africa) 0 (0.0%) 1 (0.1%)

Gamma, P.1 (Brazil) 0 (0.0%) 0 (0.0%)

Delta, B.1.617.2 (India) 50 (10.3%) 241 (12.6%)

Other 1 (0.2%) 4 (0.2%)

Unknown 247 (51.0%) 656 (34.3%)

Pregnant, N (%) 4 (2.5%) 55 (7.5%) 0.036

Indigenous, N (%) 9 (1.9%) 21 (1.1%) 0.265

Healthcare worker, N (%) 3 (2.4%) 51 (4.7%) 0.329

Admitted from nursing home / aged care hostel, N (%) 0 (0.0%) 6 (0.6%) 0.845

APACHE-II on day 1, median (IQR) 13 (10 - 17) 13 (9 - 17) 0.014

Corrected* 10 (7 - 14) 10 (7 - 14) 0.279

BMI at admission, median (IQR) 30.8 (26.8 - 35.9) 31.0 (26.3 - 36.6) 0.756

BMI group, N (%) 0.328

Underweight 0 (0.0%) 14 (0.7%)

Normal weight 54 (11.2%) 232 (12.1%)

Overweight 102 (21.1%) 404 (21.2%)

Obese - Class I 92 (19.0%) 365 (19.1%)

Obese - Class II 51 (10.5%) 196 (10.3%)

Obese - Class III 53 (11.0%) 245 (12.8%)

Not stated 132 (27.3%) 454 (23.8%)

Treatment, N (%)

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Vaccinated*

(n = 484)

Not Vaccinated

(n = 1910) p value

Antibioticsa 46 (73.0%) 704 (84.6%) 0.026

Steroids 366 (96.8%) 1411 (86.9%) < 0.001

Tocilizumab 33 (6.8%) 199 (10.4%) 0.021

Baricitinib 221 (45.7%) 552 (28.9%) < 0.001

Neutralizing antibodies 14 (2.9%) 13 (0.7%) < 0.001

Remdesivir 180 (37.2%) 747 (39.1%) 0.470

Inotrope and/or vasopressor 166 (43.2%) 778 (47.2%) 0.183

Non-invasive ventilation 194 (50.4%) 541 (32.7%) < 0.001

High-flow nasal cannula 324 (82.9%) 1205 (72.5%) < 0.001

Invasive mechanical ventilation 174 (44.6%) 844 (49.9%) 0.066

Neuromuscular blocking agentsb 20 (20.4%) 334 (34.2%) 0.008

Prone positioning 228 (58.5%) 912 (55.2%) 0.273

Extracorporeal membranes oxygenation 13 (3.5%) 77 (4.6%) 0.384

Renal replacement therapy 28 (7.3%) 127 (7.7%) 0.889

Days of non-invasive ventilation, median (IQR) 2.0 (1.0 - 4.0) 2.0 (1.0 - 4.0) 0.923

Days of ventilation, median (IQR) 9.0 (5.0 - 14.8) 10.0 (6.0 - 17.0) 0.130

Days of renal replacement therapy, median (IQR) 5.5 (2.8 - 9.2) 8.0 (3.0 - 12.0) 0.306

Days of extracorporeal membrane oxygenation, median (IQR) 29.0 (23.0 - 34.0) 23.0 (15.0 - 29.0) 0.024

ICU length of stay, days, median (IQR) 5.5 (2.4 - 10.7) 5.9 (2.7 - 13.1) 0.014

Hospital length of stay, days, median (IQR) 13.1 (8.4 - 20.0) 13.4 (8.2 - 23.0) 0.271

Outcomes, N (%) < 0.001

Discharged home 248 (51.2%) 1189 (62.3%)

Mortality - Hospital Ward 16 (3.3%) 22 (1.2%)

Mortality - ICU 72 (14.9%) 213 (11.2%)

Ongoing care in hospital ward 25 (5.2%) 81 (4.2%)

Ongoing care in ICU 71 (14.7%) 166 (8.7%)

Palliative care 1 (0.2%) 2 (0.1%)

Transfer to other hospital/facility 25 (5.2%) 106 (5.5%)

Transfer to rehabilitation 26 (5.4%) 131 (6.9%)

Unknown --- ---

Cause of death, N (%) 0.350

Treatment withdrawn, prognosis poor 43 (52.4%) 99 (46.0%)

Brain injury 2 (2.4%) 3 (1.4%)

Brain death 0 (0.0%) 2 (0.9%)

Arrhythmia 1 (1.2%) 1 (0.5%)

Cardiogenic shock 2 (2.4%) 8 (3.7%)

Distributive (septic) shock 3 (3.7%) 19 (8.8%)

Hypoxic respiratory failure 24 (29.3%) 56 (26.0%)

Metabolic 1 (1.2%) 0 (0.0%)

Other 6 (7.3%) 27 (12.6%)

* One or two doses. a Not captured since September 2021. b Not captured since March 2021.

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Paediatric

Table 5. Characteristics of paediatric (age < 16 years) patients admitted to ICU with

confirmed or managed as COVID-19

Paediatric

(n = 43)

Age at admission, median (IQR) 10 (4 - 15)

Age group at admission, N (%)

0-9 years 20 (46.5%)

10-15 years 23 (53.5%)

Sex, N (%)

Male 25 (58.1%)

Female 18 (41.9%)

Variant of concern, N (%)

None 16 (37.2%)

Alpha, B.1.1.7 (UK) 0 (0.0%)

Beta, B.1.351 (South Africa) 0 (0.0%)

Gamma, P.1 (Brazil) 0 (0.0%)

Delta, B.1.617.2 (India) 0 (0.0%)

Other 0 (0.0%)

Unknown 27 (62.8%)

Received COVID-19 vaccine, N (%) 0 / 38 (0.0%)

Indigenous, N (%) 1 (2.3%)

APACHE-II on day 1, median (IQR) 4.8 (1.3 - 11.7)

BMI at admission, median (IQR) 19.8 (13.8 - 28.5)

BMI group, N (%)

Underweight 5 (11.6%)

Normal weight 4 (9.3%)

Overweight 3 (7.0%)

Obese - Class I 1 (2.3%)

Obese - Class II 1 (2.3%)

Obese - Class III 1 (2.3%)

Not stated 28 (65.1%)

Treatment, N (%)

Antibioticsa 11 (78.6%)

Steroids 29 (69.0%)

Inotrope and/or vasopressor 11 (26.2%)

Non-invasive ventilation 10 (24.4%)

High-flow nasal cannula 18 (42.9%)

Invasive mechanical ventilation 15 (36.6%)

Neuromuscular blocking agentsb 8 (38.1%)

Prone positioning 6 (14.6%)

Extracorporeal membranes oxygenation 1 (2.4%)

Renal replacement therapy 2 (4.9%)

24


Paediatric

(n = 43)

Days of non-invasive ventilation, median (IQR) 3.0 (2.2 - 4.8)

Days of ventilation, median (IQR) 5.0 (2.0 - 8.5)

Days of renal replacement therapy, median (IQR) 3.5 (2.8 - 4.2)

Days of extracorporeal membrane oxygenation, median (IQR) 5.0 (5.0 - 5.0)

ICU length of stay, days, median (IQR) 3.2 (1.8 - 5.9)

Hospital length of stay, days, median (IQR) 5.7 (3.8 - 11.7)

Outcomes, N (%)

Discharged home 35 (81.4%)

Mortality - Hospital Ward 0 (0.0%)

Mortality - ICU 2 (4.7%)

Ongoing care in hospital ward 4 (9.3%)

Ongoing care in ICU 1 (2.3%)

Palliative care 0 (0.0%)

Transfer to other hospital/facility 1 (2.3%)

Transfer to rehabilitation 0 (0.0%)

Unknown 0 (0.0%)

* Available just in one patient. a Not captured since September 2021. b Not captured since March 2021.

25


Background

In response to the COVID-19 pandemic, the Australian and New Zealand Intensive Care Society Clinical Trials Group

(ANZICS-CTG), the Australian and New Zealand Intensive Care Research Center (ANZIC-RC), Monash University, and

with international collaborators in Oxford, launched the SPRINT-SARI database.

The goal of SPRINT-SARI was to provide near real time, detailed reporting of the sickest patients admitted to the ICU

with confirmed or suspected COVID-19 infection. This data will be used to inform the ongoing clinical management

of such patients and the public health response.

Methods

Participating sites across Australia were identified following an expression of interest to ANZICS-CTG affiliated sites,

or through previous affiliation with the SPRINT SARI AUS team. The ANZICS-CTG is a well-established research

network with highly experienced research coordinators familiar with conducting high quality research studies.

The case report form (CRF) had extensive development by local and international clinical experts, and includes

standardized data fields that align with our international SPRINT-SARI collaborators.

Data in this report was entered by the research coordinator at the participating site. The patients relevant

background and presenting symptoms were recorded on the day of study recruitment. Daily follow-up was then

completed until discharge from ICU. A final form was competed with details of the hospital outcomes.

To support the rapid institution of data collection and reporting, SPRINT-SARI AUS hosts a data platform that

includes an electronic data capture system, a secure repository and an analytic framework. Data are entered to a

web-based REDCap data management system, securely stored, and used to inform regular reports as above. All

analysis was performed by the Monash University team using Stata version 16 (Stata Corp, College Station, Tx, USA)

and R statistical software (R Core Team, 2019).

Descriptive statistics and bar graphs were reported in this report to summarise patient demographics and clinical

characteristics for confirmed COVID-19 patients. Continuous variables have been reported with the mean and

standard deviation (SD) or median and interquartile range (IQR) and frequencies and percentages have been

presented for categorical variables.

In some instances, categories are collapsed due to small numbers and with appropriate clinical input. Length of stay

(LOS) in ICU/hospital has been reported as the observed median time from ICU/hospital admission date to

ICU/hospital discharge date and the IQR is also presented as observed LOS in ICU/hospital at the 25th and 75th

percentiles.

Human Research Ethics Committee (HREC) approval for data collection, with a waiver of informed consent, was

granted via the National Mutual Acceptance (NMA) scheme, through the Alfred (HREC/16/Alfred/59), or by separate

applications to individual sites. Research Governance approval was granted by the Chief Health Officer (CHO) in

South Australia and Victoria, and supported by the CHO in Queensland, under legislated public health

powers. Individual site Research Governance approvals were granted at all sites where it was required.

26


Acknowledgements

Participating sites

ACT Canberra Hospital SA The Queen Elizabeth Hospital

NSW Bankstown-Lidcombe Hospital SA Wakefield Hospital

NSW Calvary Mater Newcastle TAS Launceston Hospital

NSW Campbelltown Hospital TAS Royal Hobart Hospital

NSW Children's Hospital at Westmead VIC Albury Wodonga Health

NSW Concord Hospital VIC Angliss Hospital

NSW John Hunter Hospital VIC Austin Hospital

NSW Liverpool Hospital VIC Ballarat Base Hospital

NSW Nepean Hospital VIC Barwon Health

NSW Prince of Wales Hospital VIC Bendigo Hospital

NSW Royal North Shore Hospital VIC Box Hill Hospital

NSW Royal Prince Alfred Hospital VIC Cabrini Hospital

NSW St George Hospital VIC Casey Hospital

NSW St Vincent's Hospital Sydney VIC Dandenong Hospital

NSW Westmead Hospital VIC Epworth Richmond

NSW Wollongong Hospital VIC Footscray Hospital

NSW Sydney Children's Hospital, Randwick VIC Frankston Hospital

NT Alice Springs Hospital VIC Maroondah Hospital

NT Royal Darwin Hospital VIC Mildura Base Hospital

QLD Bundaberg Hospital VIC Monash Children's Hospital

QLD Caboolture Hospital VIC Monash Medical Centre

QLD Cairns Hospital VIC Northeast Health Wangaratta

QLD Gold Coast Hospital VIC Royal Children's Hospital

QLD Hervey Bay Hospital VIC Royal Melbourne Hospital

QLD Ipswich Hospital VIC St Vincent's Hospital Melbourne

QLD Logan Hospital VIC Sunshine Hospital

QLD Mater Misericordiae Limited VIC The Alfred Hospital

QLD Princess Alexandra Hospital VIC The Northern Hospital

QLD Queensland Children's Hospital VIC Warrnambool Base Hospital

QLD Redcliffe Hospital VIC Werribee Mercy Hospital

QLD Royal Brisbane and Women's Hospital WA Bunbury Hospital

QLD Sunshine Coast University Hospital (ICU and PCCU)

WA Fiona Stanley Hospital

QLD The Prince Charles Hospital WA Joondalup Health Campus

QLD Toowoomba Hospital WA Perth Children's Hospital

SA Adelaide Women's and Children's Hospital WA Rockingham General Hospital

SA Ashford Community Hospital WA Royal Perth Hospital

SA Flinders Medical Centre WA Sir Charles Gairdner Hospital

SA Flinders Private Hospital WA St John of God Midland

SA Lyell McEwin WA St John of God Murdoch

SA Royal Adelaide Hospital

Notes: All sites have Ethics approval either under NMA (The Alfred Hospital) or local HREC authority. All sites have governance

authority to enter data either through jurisdictional Enhanced Surveillance or through local governance approval.

27


Statistical analysis and reporting team

Aidan Burrell Monash University, DEPM, SPHPM, ANZIC-RC

Andrew Udy Monash University, DEPM, SPHPM, ANZIC-RC

Ary Serpa Neto Monash University, DEPM, SPHPM, ANZIC-RC

Tony Trapani Monash University, DEPM, SPHPM, ANZIC-RC

Tessa Broadley Monash University, DEPM, SPHPM, ANZIC-RC

Patricia V. Alliegro Monash University, DEPM, SPHPM, ANZIC-RC

sprint sari (aust) management committee sphpm - sprint

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