Recognition, management, and transport of sick cardiac children

Due to the centralization of specialized cardiology, cardiac surgery, and intensive care services in various regions worldwide, critically ill cardiac children frequently require stabilization and safe transport to tertiary centers for further management whether in terms of diagnosis or further intervention. Ensuring optimal stabilization before transport is critical, as these patients have complex circulatory physiology and are particularly vulnerable to physiological disruptions during transport, including acceleration-deceleration forces and ventilation changes. Hence, it requires close monitoring. Given the potential for rapid deterioration, inter-hospital transport should ideally be conducted by teams with specialized training in pediatric cardiac critical care and transport. However, in low- and middle-income countries, inter-facility transport often involves long-distance road travel in inadequately equipped ambulances, often without trained medical personnel, to few specialized centers. In addition, these regions frequently lack robust communication systems, in-transit monitoring, and standardized disease-specific protocols. As a result, suboptimal transport with delayed presentation at surgical centers significantly compromises outcomes and increases the demand for intensive care resources. This highlights the critical need for “safe and optimal transport” in these settings.