Leveraging a cloud-based critical care registry for pandemic surveillance and research in low and middle-income countries (Preprint)

UNSTRUCTURED The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive healthcare action in low and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) compliant real-time reporting of severe acute respiratory infection (SARI). The registry platform's cloud-based common data model and standardized nomenclature assures interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics provide stakeholders with real time visualization of individual and aggregate epidemiological, clinical and operational data. The PRICE operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC compliant SARI reporting was successfully implemented by leveraging existing PRICE infrastructure in all 49-member intensive care units (ICUs), enabling clinicians, operational leads and established stakeholders with responsibilities for coordinating the pandemic response to have access to real-time information on suspected and confirmed COVID-19 cases (n=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, healthcare worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multi-center clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance and resource planning.