Multinational collaborations in critical care research: feasible and useful?

Abstract

Purpose of review: Multinational collaborative research has become indispensable for generating evidence capable of informing critical care practice across diverse healthcare systems. This review examines the current landscape of multinational research models including registry-based studies, society-led networks, and south-south collaborations, and evaluates the evidence on their feasibility, scientific value, and emerging methodological innovations.

Recent findings: National and multinational ICU registries underpin a growing number of observational studies, adaptive platform trials, and quasi-experimental research. Federated analysis and target trial emulation have emerged as particularly promising approaches for leveraging existing registry data while respecting data governance constraints, with the SOFA-2 development using data from 3.34 million patients across nine countries exemplifying what multinational federated methodology can achieve. Scientific societies and regional networks have driven several landmark studies including REMAP-CAP, WEAN SAFE, LUNG SAFE, CENTER-TBI and the ISCCM ResearchNet, which have demonstrated the feasibility of cost-effective, large-scale international collaborations. South-south collaborations are increasing and are fundamental to advancing equity in evidence generation, mitigating the systematic underrepresentation of low- and middle-income country (LMIC) populations in critical care research.

Summary: Multinational collaboration is currently a major source of scientific evidence. The infrastructure, methods, and networks have evolved and are able to support research that is simultaneously rigorous, representative, and relevant across healthcare systems. Sustained investment in interoperable registries, equitable partnerships, and capacity-building will determine whether this momentum translates into improvements in critical care outcomes globally.