• COVID-19
• resuscitation

The WHO declared COVID-19 a pandemic in March 2020. By the end of 2020, the US Centers for Disease Control and Prevention demonstrated that the cumulative rate of COVID-19-associated hospitalisations for patients <18 years of age was 23.9 per 100 000 population compared with adults 18 or older at 449.9 per 100 000 population.1 A recent assessment done by the Society of Critical Care Medicine estimated that the USA had 34.7 critical care beds per 100 000 population; 5% of which are paediatric critical care beds and 24% being neonatal intensive care beds.2 The resultant shortage of adult intensive care unit (AICU) resources due to the surge of COVID-19 infections sparked ingenuity in a time when the world was thrust into chaos.

Amid this, Sinha et al in this issue found creative ways for children’s doctors to care for sick adults with COVID-19 disease.3 In a carefully crafted rubric, the authors show how thoughtful planning and methodical implementation in England can mobilise emergency resources in a time of crisis. As such, their success met the demand to increase AICU resources during the early surge of the COVID-19 pandemic while still meeting the paediatric critical care needs of the country.

At the beginning of the pandemic a number of adult and paediatric-trained critical care physician experts developed recommendations on how to care clinically for adults in paediatric settings.4 5 As the world disaster continued to unfold, several models to implement these recommendations began to take shape in three differing models: exclusive management of adults in paediatric ICUs (PICU) with a centrally located PICU regionally to care for children, a hybrid adult and PICU, or …