Interhospital transport of patients with time-critical cardiac emergencies by an adult critical care transfer team

Introduction: Due to centralisation of cardiac care, patients with acute cardiac conditions commonly require interhospital transfer. We aimed to describe the epidemiology and management of patients with time-critical cardiac emergencies by one UK Adult Critical Care Transfer Service (ACCTS) and identify potentially modifiable factors associated with prolonged packaging and transfer time. Methods: We conducted an observational cohort study of all patients referred to the ACCESS London ACCTS between 1 April 2023 and 1 April 2025 where the reason for transfer was escalation of care for specialist cardiac services. Patients with acute aortic syndromes and thoracic surgery were excluded. We assessed outcomes of transfer mortality, mortality at 72 h and packaging time. We conducted multivariable linear regression to identify exposures associated with prolonged packaging time as a potentially modifiable factor. Results: Of 466 patients meeting criteria who were referred for transfer, 406 were transferred by our ACCTS. The commonest primary diagnoses were acute myocardial ischaemia (136/406, 33%) and unstable arrhythmia (112/406, 28%). Non-invasive or invasive ventilatory support was used in 193/406 patients (48%) and vasopressor/inotrope support in 256/406 (63%). Death in transfer occurred in two patients, and of 401 patients with follow-up at 72h, 372 (93%) were alive. The median (interquartile range) packaging time was 44 (33, 60) min and median transit time 29 (21, 38) min. Factors associated with prolonged packaging time included use of invasive ventilation ( ß = 12.8 (7.4, 18.3) min, p < 0.001), non-invasive ventilation ( ß = 23.7 (10.6, 36.8) min, p < 0.001), increasing number of vasoactive infusions ( ß = 7.7 (4.1, 11.2) minutes per additional infusion, p < 0.001) and consultant-led transfer ( ß = 19.4 (10.1, 28.8) min, p < 0.001). Conclusions: Adult critical care transfer services can provide safe and efficient transfer of patients with cardiac emergencies.