Interhospital Transfer of Critically Ill Cardiac Patients

OBJECTIVES: To review the systems of care, logistics, staffing considerations, and best practices to facilitate safe interhospital transfer of critically ill patients with cardiac pathology. DATA SOURCES: Publications were identified using a Medline search using terms related to interhospital transfer, systems of care, published guidelines, and cardiac conditions. STUDY SELECTION: A screening and shortlisting process was carried out by three of the authors to identify relevant studies, case reports, and guidelines. DATA EXTRACTION: Data from relevant articles were qualitatively evaluated. DATA SYNTHESIS: The interhospital transfer of critically ill cardiac patients presents significant clinical and logistical challenges. These patients benefit from access to specialized care but require meticulous physiologic management during transport and are at risk of deterioration. Structured communication systems, telemedicine, and specialized critical care transfer teams enhance patient selection, pre-transfer optimization, and in-transit management. The use of mechanical circulatory support devices, such as intra-aortic balloon pumps and microaxial flow pumps, adds further complexity. CONCLUSIONS: Despite the high-acuity nature of these transfers, evidence from case series and observational studies demonstrates that, with appropriately trained teams and rigorous protocols, critically ill cardiac patients can be safely transported between facilities. This review highlights the importance of structured protocols, telemedicine, and specialized transport teams.