Introduction: Severe malaria is a life-threatening emergency and a leading cause of intensive care admission in sub-Saharan Africa, yet data from Guinean intensive care units are scarce. The aim of this study was to describe the epidemiological, clinical and outcome profile of patients admitted for severe malaria in the intensive care units of the Conakry University Hospitals. Patients and Methods: This was a retrospective, descriptive cross-sectional study conducted over 24 months, from 1 January 2024 to 31 December 2025, in the Departments of Anaesthesia and Intensive Care of Donka National Hospital and Ignace Deen University Hospital. All patients with a positive rapid diagnostic test or thick blood smear and at least one WHO severity criterion were included. Results: Forty-eight patients were included, corresponding to a hospital frequency of 13.2%. The mean age was 24.21 ± 11.25 years (range: 4–64 years), with a male-to-female ratio of 1.52. Most patients were students (54.2%), had no health insurance (91.7%) and lived outside Conakry (87%). Altered consciousness (87.5%) and seizures (62.5%) were the main presenting signs. Thrombocytopenia (83.3%) and raised creatinine (47.9%) were the most frequent laboratory abnormalities. All patients received intravenous artesunate. The main complications were acute kidney injury (41.7%) and persistent seizures (37.5%). The mean hospital stay was 7.18 ± 4.66 days. Mortality was 27.1% (13 deaths), due to septic shock in 61.5% and hypoxaemic cardiac arrest in 38.5% of casesb. Conclusion: Severe malaria in the intensive care units of Conakry mainly affects young, uninsured patients referred from outside the capital with severe neurological involvement, and carries a high mortality. Earlier referral, strict adherence to artesunate protocols and better monitoring are needed to reduce morbidity and mortality.