ISOREA Survey Finds Wide Variation in ICU Resources Across Countries

The ISOREA survey collected structured data on hospital and ICU characteristics from participating centers between January 2018 and July 2020. The questionnaire covered 237 items on general characteristics, resources, and organization. Of 1,426 ICUs recruited across five continents, 1,225 were analyzed: 58% were in high-income countries (HICs), 20% in upper-middle-income countries, and 22% in low- or lower-middle-income countries (LLMICs). Most were in referral centers (90%) and large urban areas (80%).

Ninety-three percent of assessed variables were significantly associated with income group; 88% were higher in HICs and lower in LLMICs. Disparities were prominent in extracorporeal and respiratory support, emergency access to interventional radiology and surgery, neurology and trauma care, monitoring, and cardiovascular and hemodynamic care. By Marshall classification, 79% of HIC ICUs were level III, while 55% of LLMIC ICUs were level I.

Higher-performing domains varied mainly between countries, while lower-performing domains showed more variation among ICUs within the same country. Adjustment for income reduced, but did not eliminate, country-level clustering. The findings describe structural and organizational differences, but the survey’s concentration in referral centers and large urban areas may limit generalizability to other facilities. The supplied abstract does not report clinical outcomes.