Introduction

When critically ill cardiac patients are moved, either within the hospital or between hospitals, the principles of safe transfer should be applied regardless of the distance travelled or the underlying diagnosis. Interhospital transfers in particular require a high level of expertise because further skilled help may not be readily available if problems occur en route. These transfers have significant associated risk and the transfer period has been shown to be one of the most hazardous phases in any episode of critical care. There must be a local strategy in place to manage the process, so that safe and efficient coordination can take place on a 24-hour basis.

Additional invasive monitoring and organ support before transfer may be required. Compact technology to analyze blood gases and electrolytes during transfer is now readily available and should be used, especially during prolonged journeys. Thrombolytic therapy, pacing and defibrillation have been shown to be both effective and safe during transport. Bypass circuits and left ventricular assist devices represent the current extremes of cardiac support during transfer, used only by selected specialist centres with fully trained medical, nursing and technical staff in attendance.

In general, the aim of transfer is to upgrade the level of care or obtain appropriate specialist diagnostic or treatment facilities. Transfer is associated with complications; even the physical movement from a bed to a stretcher or examination table may be hazardous. Complications range in severity from minor to potentially life threatening and may be related to clinical, equipment or organizational problems.