A robust national critical care research ecosystem that drives innovation, improves patient outcomes and informs clinical practice and policy decisions by fostering collaboration, building research capacity, and translating discoveries into real-world solutions.

Our mission is to advance critical care research by fostering interdisciplinary collaborations, enhancing research capacity, and conducting high-quality, impactful studies. Through rigorous inquiry and innovation, we seek to address key challenges in critical care, translate research findings into improved patient care, and shape evidence-based clinical practices and healthcare policies across the nation.

• CCM Epidemiology
• Emerging Infections & Pandemic Preparedness
• Patient & Public Involvement & Engagement
• Antimicrobial Resistance & Stewardship
• Long-Term Outcomes of Critical Illness
• Genomics in Critical Care
• Trials Methodology
• Machine Learning

The Mega-ROX trial is a large-scale, multi-centre, randomised clinical study investigating optimal oxygen therapy strategies for mechanically ventilated adults in intensive care. Embedded within PRICE, this study examines whether a conservative approach to oxygen therapy reduces mortality compared to a liberal approach, while also exploring whether liberal oxygen therapy may benefit certain groups, such as patients with acute brain pathologies (excluding hypoxic brain injuries) and those with sepsis. Ziauddin University contributes to this global effort with an enrollment number of 236 patients, as of July 2024, with Pakistan accounting for 20% of the total enrollments.

https://zu.edu.pk/mega-rox/ 

GenOMICC investigates the genetic factors influencing susceptibility to life-threatening infections and sterile injuries. In collaboration with the International Severe Acute Respiratory Infection Consortium (ISARIC) and the International Forum of Acute Care Trialists (InFACT), this study aims to establish a DNA resource for genome-wide discovery of host genetic variants that affect patient outcomes. By analysing DNA samples from critically ill patients in Pakistan, the research seeks to identify key genetic mechanisms that could lead to new therapeutic targets for improving survival in severe infections and systemic injuries.

Ziauddin University is the coordinating centre for other GenOMICC sites, achieving 299 successful enrollments as of September 2024.

https://genomicc.org/countries/pakistan/ 

REMAP, is a Randomised, Embedded, Multifactorial, Adaptive Platform trial. The broad objective of this trial is, over time, to determine and continuously update the optimal set of treatments for community-acquired pneumonia. This trial is an innovative global research initiative designed to improve the treatment of community-acquired pneumonia (CAP) including COVID-19, particularly in severe cases that require admission to an Intensive Care Unit (ICU). REMAP-CAP uses an adaptive platform trial design that allows for the simultaneous testing of multiple treatments across different domains. The trial evolves by incorporating new treatment options and adjusting strategies based on real-time data.

Ziauddin University is the coordinating centre for other REMAP-CAP sites and successfully enrolled patients in the Vitamin C, Ivermectin, Statin, and Oseltamivir domains. In the Ivermectin domain, 98% of enrollments are from Pakistan.

https://zu.edu.pk/ccrg/remap-cap/

https://www.remapcap.org/participating-sites

The ISARIC-WHO Clinical Characterisation Protocol (CCP) is a standardised protocol for the
rapid, coordinated clinical investigation of severe or potentially severe illness caused by
emerging or high-consequence pathogens or other noxious exposures of public health interest.
It is an adaptable protocol depending on a site’s resources and works in a tiered approach:

○ Tier 0: Data collection
○ Tier 1: Data collection and on-admission samples
○ Tier 2 – 3: Data collection and serial sampling depending on resources

The following studies utilise CCP:

• Characteristics and outcomes of patients with severe Dengue
  A prospective observational study designed to analyse the clinical presentation, disease
  progression, and outcomes of patients with severe dengue in intensive care units (ICUs) across Pakistan. The project leverages ISARIC-WHO Clinical Characterisation Partnership (CCP) framework, which is designed to capture globally harmonised data on dengue and is publicly accessible through;

https://isaric.org/research/dengue/dengue-clinical-characterisation-protocol/

• COVID-19 FOLLOW-UP
  A multicentre, prospective and retrospective observational study to assess the long-term impacts of COVID-19 on ICU survivors across Pakistan. This study examines the prevalence of Long-COVID symptoms and monitors both physical and psychosocial outcomes in patients with confirmed or suspected SARS-CoV-2 infection. Using the ISARIC-WHO COVID-19 follow-up protocol, the study conducted retrospective follow-up on patients discharged between August 1, 2021, and January 31, 2022, and follows new ICU admissions at regular six-month intervals in a prospective cohort.

https://isaric.org/research/covid-19-clinical-research-resources/covid-19-long-term-follow-up-study/

Five waves of COVID-19: Insights from the Pakistan Registry of Intensive CarE (PRICE)

This is a multicentre prospective observational study analysing the demographics, clinical characteristics, and outcomes of 9,102 patients with SARS-CoV-2 infection admitted to 69 PRICE-collaborating intensive care units (ICUs) across Pakistan from April 2020 to March 2022 during the five waves of the pandemic. 

ACORN-HAI is a surveillance designed to address the growing threat of antimicrobial resistance (AMR) in healthcare-associated infections (HAIs) within Pakistan. This project focuses on severe infections, particularly in intensive care units (ICUs), surgical wards, and cancer care settings, where multidrug-resistant organisms (MDROs) are most prevalent. The study aims to monitor and document the incidence and prevalence of AMR in HAIs, specifically focusing on bloodstream infections (BSI) and ventilator-associated pneumonia (VAP).

Ziauddin University has successfully implemented the study across both North and Clifton campuses and has enrolled 212 patients as of October 2024.

https://wellcomeopenresearch.org/articles/8-179

The Pakistan Registry of Intensive CarE (PRICE) is a network of more than eighty intensive care units (ICUs) across Pakistan, including both public and private sector institutions. Established as a clinician-led initiative, PRICE aims to standardise and improve critical care practices throughout the country. The registry prospectively collects clinical and demographic data on consecutive adult ICU admissions, providing detailed information on the case mix, including presentation, diagnosis, comorbidities, severity of illness, organ support days, ICU mortality, and care processes. It provides a platform for evaluating the quality of care, implementing quality improvement initiatives, and facilitating registry-based research and platform trials within Pakistani ICUs.

https://reach.com.pk/price.html 

Oxygen requirements and approaches to respiratory support in patients with COVID-19 in low- and middle-income countries (O2CoV2) was an observational study conducted by WHO between March – April 2022. The study aimed to characterise type and duration of different modalities of oxygen therapy delivered to patients; describe demographics and outcomes of hospitalised patients with COVID-19; and describe facility-level oxygen production and support. The study was implemented in 30 countries representing four LMICs from each of the six WHO regions. Pakistan successfully contributed 67 enrolments.

A multicentre, randomised trial conducted between May 2020 and March 2022. It aimed to assess whether medical masks provided non-inferior protection compared to N95 respirators in preventing COVID-19 among healthcare workers. Participants were randomly assigned to wear either medical masks or fit-tested N95 respirators for 10 weeks. The study was conducted across 29 healthcare facilities in Canada, Israel, Pakistan, and Egypt, involving 1,009 healthcare workers. Of these, 186 participants were from Pakistan.

The South Asian Hub lead by Professor Hashmi has taken initiatives to improve patient care in Pakistan by standardising data collection processes, which has led to the identification of gaps in patient management and fostered an informed ‘community of healthcare professionals’ within the network. Expanding on ISARIC’s preparedness endeavours and leveraging established connections within the Pakistan Registry of Intensive Care (PRICE), the integration of the ISARIC WHO Case Report Form into the PRICE registry has significantly enhanced data gathering efforts across 80 ICUs. This pioneering approach, which embeds data collection mechanisms within existing registries, enabled the REMAP-CAP collaborative to carry out their trial for COVID. Regular reports on outcomes of COVID-19 patients admitted to ICUs empowered healthcare professionals with valuable insights to optimise patient care.

Additionally, the Karachi Hub established a comprehensive framework for follow-up studies, incorporating approaches involving patient communities, including implementing follow-up calls post-discharge with access to medical professionals, and designing concise, user-friendly questionnaires for telephone surveys.

https://isaric.org/regional-hubs-case-studies/ – pakistan

The Critical Care Research Team has been awarded the prestigious WHO-SHQ-RFP-24-2020 grant for their proposal to create a globally applicable Clinical Trials Unit (CTU) maturity framework. The project will focus on developing standards and guidance for CTUs, ensuring their capacity to manage high-quality clinical trials in diverse settings. The framework will be piloted across multiple WHO regions, enhancing its global applicability and impact.

1. Evaluation of the Establishment of a Public and Patient Involvement and Engagement Group to Support Clinical Trials in Pakistan: Protocol for a Mixed-Methods Study
   Authors: Arishay Hussaini, Monaza Khan, Nikhat Ahmed, Madiha Hashmi, Shehla Farooq, Adnan Masood, Srinivas Murthy, Saima Saleem, Zahyd Shuja, Shahnaz Zaman, Arjen M Dondorp, Timo Tolppa
   Wellcome Open Res. 2025;10:162. doi:10.12688/wellcomeopenres.23687.2.


2. Patient and public involvement and engagement in critical care research in low and middle-income countries: challenges and solutions
   Authors: Arishay Hussaini, Nikhat Ahmed, Maham Jawaid Ahmed, Madiha Hashmi, Timo Tolppa
   Crit Care Sci. 2025;37:e20250089. doi:10.62675/2965‑2774.20250089.


3. Co-designing the consent process of critical care trials with patients and the public: Project protocol
   Authors: Timo Tolppa, Arishay Hussaini, Vrindha Pari, Nikhat Ahmed, Arjen Dondorp, Shehla Farooq, Madiha Hashmi, Monaza Khan, Adnan Masood, Saima Saleem, Zahyd Shuja, Marianne Vidler, Shahnaz Zaman, Srinivas Murthy
   Wellcome Open Res. 2025;10:23916. doi:10.12688/wellcomeopenres.23916.1.


4. Clinical characteristics of COVID-19 patients admitted to the intensive care unit of the largest public-sector hospital in Karachi: A retrospective, observational study.
   Authors: Muhammad Tanveer Alam, Aasma Khan, Arjan Kumar, Muhammad Rehan, Imran Sarwar Shaikh, Nazia Azam Yousfani
   Prof Med J. 2024;31(11):8392. doi:10.29309/TPMJ/2024.31.11.8392.


5. Establishment of a patient and public involvement and engagement group to support clinical trials in Pakistan: Initial lessons learned
   Authors: Timo Tolppa, Arishay Hussaini, Nikhat Ahmed, Arjen M. Dondorp, Shehla Farooq, Monaza Khan, Adnan Masood, Srinivas Murthy, Saima Saleem, Zahyd Shuja, Shahnaz Zaman and Madiha Hashmi.
   Res Involv Engagem. 2024;10:635. doi:10.1186/s40900-024-00635-6.


6. A retrospective, observational study to assess the intermediate-term clinical outcomes of COVID-19 patients in a tertiary hospital in Khyber Pakhtunkhwa, Pakistan
   Authors: Muhammad Sheharyar Ashraf, Arishay Hussaini, Dilanthi Priyadarshani Gamage Dona, Mohiuddin Shaikh
   Anaesth Pain Intensive Care. 2024;28(2):198-205. doi:10.35975/apic.v28i2.2423.


7. Simvastatin in Critically Ill Patients with Covid-19
   Authors: Derek Angus, Yaseen Arabi, Diptesh Aryal, Abigail Beane, Carolyn Calfee, Rabindrarajan Ebenezer, Ewan Goligher, Anthony Gordon, Cameron Green, Rashan Haniffa, Madiha Hashmi, Thomas Hills, Deva Jayakumar, Peter Kruger, Patrick Lawler, Colin McArthur, Daniel McAuley (Chair), Bryan McVerry, Matthew Neal, Alistair Nichol, Cecilia O’Kane, Murali Shyamsundar, Pratik Sinha, Taylor Thompson, Steve Webb, Ian Young
   N Engl J Med. 2023;389:NEJMoa2309995. doi:10.1056/NEJMoa2309995.


8. Intravenous Vitamin C for Patients Hospitalized With COVID-19 – Two Harmonized Randomized Clinical Trials
   Authors: Neill K. J. Adhikari, Madiha Hashmi, Bharath Kumar Tirupakuzhi Vijayaraghavan, Rashan Haniffa, Abi Beane, Steve A. Webb, Derek C. Angus, Anthony C. Gordon, Deborah J. Cook, Gordon H. Guyatt, Lindsay R. Berry, Elizabeth Lorenzi, Paul R. Mouncey, Carly Au, Ruxandra Pinto, Julie Ménard, Sheila Sprague, Marie-Hélène Masse, David T. Huang, Daren K. Heyland, Alistair D. Nichol, Colin J. McArthur, Angelique de Man, Farah Al-Beidh, Djillali Annane, Matthew Anstey, Yaseen M. Arabi, Marie-Claude Battista, Scott Berry, Zahra Bhimani, Marc J. M. Bonten, Charlotte A. Bradbury, Emily B. Brant, Frank M. Brunkhorst, Aidan Burrell, Meredith Buxton, Maurizio Cecconi, Allen C. Cheng, Dian Cohen, Matthew E. Cove, Andrew G. Day, Lennie P. G. Derde, Michelle A. Detry, Lise J. Estcourt, Elizabeth O. Fagbodun, Mark Fitzgerald, Herman Goossens, Cameron Green, Alisa M. Higgins, Thomas E. Hills, Christopher Horvat, Nao Ichihara, Devachandran Jayakumar, Salmaan Kanji, Muhammad Nasir Khoso, Patrick R. Lawler, Roger J. Lewis, Edward Litton, John C. Marshall, Daniel F. McAuley, Anna McGlothlin, Shay P. McGuinness, Zoe K. McQuilten, Bryan J. McVerry, Srinivas Murthy, Rachael L. Parke, Jane C. Parker, Luis Felipe Reyes, Kathryn M. Rowan, Hiroki Saito, Nawal Salahuddin, Marlene S. Santos, Christina T. Saunders, Christopher W. Seymour, Manu Shankar-Hari, Timo Tolppa, Tony Trapani, Alexis F. Turgeon, Anne M. Turner, Andrew A. Udy, Frank L. van de Veerdonk, Ryan Zarychanski, François Lamontagne
   JAMA. 2023;330:21407. doi:10.1001/jama.2023.21407.


9. PRICE COVID19 Data Report December 2021
   Authors: Ahmed Farooq, Aisha Kulsoom Mufti, Aneela Altaf, Arsalan Rahatullah, Arshad Taqi, Ashok Kumar, Attaur Rehman, Fakhir Raza Haidri, Iqbal Hussain, Irfan Malik, Jodat Saleem, Liaquat Ali, Mobin Chaudhry, Muhammad Sheharyar Ashraf, Mohiuddin Sheikh, Muhammad Ashraf Zia, Muhammad Asim, Muhammad Asim Rana, Muhammad Hayat, Muhammad Nasir Khoso, Naseem Ali Shaikh, Nawal Salahuddin, Qurat-ul-Ain Khan, Rana Imran Sikander, Rashid Nasim Khan, Saadiya Rizvi, Safdar Rehman, Sairah Babar, Syed Muneeb Ali, Abigail Beane, Aasiyah Rashan, Arjen M Dondorp, Chamira Kodippily, Himasha Muvindi, Dilanthi Priyadarshani, Ishara Udayanga, Rashan Haniffa, Sri Darshana, Srinivas Murthy, Thalha Rashan, Thalha Rashan, Aasiyah Rashan, Rashan Haniffa, Abigail Beane, Madiha Hashmi
   medRxiv. 2022. doi:10.1101/2022.01.20.22269202.


10. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system.
    Authors: Diptesh Aryal, Abi Beane, Arjen M. Dondorp, Cameron Green, Rashan Haniffa, Madiha Hashmi, Devachandran Jayakumar, John C. Marshall, Colin J. McArthur, Srinivas Murthy, Steven A. Webb, Subhash P. Acharya, Pramodya G. P. Ishani, Issrah Jawad, Sushil Khanal, Kanchan Koirala, Subekshya Luitel, Upulee Pabasara, Hem Raj Paneru, Ashok Kumar, Shoaib Siddiq Patel, Nagarajan Ramakrishnan, Nawal Salahuddin, Mohiuddin Shaikh, Timo Tolppa, Ishara Udayanga, Zulfiqar Umrani
    Wellcome Open Res. 2021;6:16486. doi:10.12688/wellcomeopenres.16486.1.


11. Pakistan Registry of Intensive CarE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia
    Authors: Madiha Hashmi, A Beane, A Taqi, M I. Memon, P Athapattu, Z Khan, A M. Dondorp, R Haniffa
    J Intensive Care Soc. 2018;19:339‑47. doi:10.1177/1751143718814126.