Patient outcomes following transfer between intensive care units during the COVID‐19 pandemic

Abstract

Summary Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID‐19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID‐19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID‐19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter‐hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra‐hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty‐five patients underwent inter‐hospital transfers compared with 92 intra‐hospital transfers. There was no significant change in median compliance 6 h pre‐transfer, immediately post‐transfer and 24 h post‐transfer in patients who underwent either intra‐hospital or inter‐hospital transfers. For inter‐hospital transfers, there was an initial drop in median PaO2/FIO2 ratio: from median (IQR [range]) 25.1 (17.8–33.7 [12.1–78.0]) kPa 6 h pre‐transfer to 19.5 (14.6–28.9 [9.8–52.0]) kPa immediately post‐transfer (p < 0.05). However, this had resolved at 24 h post‐transfer: 25.4 (16.2–32.9 [9.4–51.9]) kPa. For intra‐hospital transfers, there was no significant change in PaO2/FIO2 ratio. We also found no meaningful difference in pH; PaCO2;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID‐19 undergoing mechanical ventilation of the lungs may have short‐term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID‐19 pandemic.

Developments in adult critical care transfer in England: a positive legacy of the COVID‐19 pandemic

“…Within the NHS in England, the requirement to deliver these transfers led to the rapid development of temporary transfer services, including those described by Huq et al. [ 8 ]. Subsequent work has driven a dramatic and permanent change to the provision of adult critical care in England.…”

“…Huq et al. [ 8 ] investigated the transfer of COVID‐19 critical care patients between different hospitals sites within a large NHS Trust in their region of London over a 12‐month period that covered the first two major pandemic waves in the UK. They compared intubated and ventilated patients with confirmed SARS‐CoV‐2 infection requiring inter‐hospital transfer for capacity reasons with those requiring intra‐hospital transfer between different critical care units within the same hospital and examined the physiological status pre‐ and post‐transfer as well as outcome.…”

“…The paper by Huq et al. [ 8 ] is one of a series from around the world [ 9 , 10 , 11 ] which have variably assessed the efficacy, physiological effects and outcomes of patients requiring critical care transfer during the pandemic. Evidence published before 2020 has long suggested that critical care transfer can be carried out safely by dedicated transfer and retrieval teams [ 1 ], with the best evidence from countries with well‐developed systems such as Australia.…”

“…While some had recognised this should change [4], and national guidelines and safety reports had recommended improvements [5][6][7], funding and resources were lacking. This landscape was the situation within which Huq et al [8] found themselves at the beginning of the COVID-19 pandemic.…”

“…This landscape was the situation within which Huq et al. [ 8 ] found themselves at the beginning of the COVID‐19 pandemic.…”