COVID-19: the practice of transferring intensive care patients at the intersection of medicine, economics and politics : a systematic review of clinical evidence

The Coronavirus Disease 2019 (COVID-19) pandemic imposed unprecedented challenges on global healthcare systems, forcing rapid adaptations in healthcare policies and patient management practices. Among the most critical issues faced was the need to manage intensive care unit (ICU) capacities, as surges in severe COVID-19 cases led to acute respiratory failure requiring advanced respiratory support and, in many cases, ICU transfer from overwhelmed facilities was necessary. Although patient transfers, especially of critically ill individuals, traditionally carry a degree of risk, their role in balancing ICU capacity and distributing critical care resources became essential during the pandemic. Many studies outside of the COVID-19 context have shown that patient transfers are associated with varying clinical outcomes. While transfers of critically ill patients have not consistently led to increased mortality, some studies have shown that patient transfers may contribute to longer ICU and hospital stays, raising concerns about the resource demands and potential impacts on patient recovery. Within the COVID-19 context, the implications of patient transfer for severely ill patients have gained renewed importance, particularly as healthcare systems worldwide had to prepare for and manage high patient volumes in times of crisis.