Longer ED-to-ICU transfer was linked to death after cardiac arrest in academic hospitals only

Design

Secondary analysis of a retrospective multicentre cohort (Netherlands, 2009–2020)

Population

18,798 adults admitted directly from ED to ICU in 12 hospitals

Primary outcome

Hospital mortality by ED-to-ICU time quintile

Effect

OHCA in academic hospitals: OR 2.94 (95% CI 1.80–4.78) at >3.4 h; no association in sepsis, pneumonia, overdose, ICH

This secondary analysis of a Dutch cohort (2009 to 2020, published June 2026) included 18,798 adults admitted directly from the emergency department to intensive care in 12 hospitals. Median ED-to-ICU time was 1.9 hours.

After out-of-hospital cardiac arrest, longer transfer time was associated with higher mortality in academic hospitals (OR 2.94, 95% CI 1.80 to 4.78 above 3.4 hours) but the opposite pattern appeared in non-academic teaching hospitals. In non-operative trauma, an association in the whole cohort disappeared when hospitals were analysed separately. There was no association in sepsis, pneumonia, respiratory failure, overdose or intracranial haemorrhage.

The inconsistent pattern suggests that transfer time often reflects why a patient waited, such as stabilisation, imaging or catheter lab time, rather than causing harm itself. Crowding still matters; this study just cannot isolate its effect.

• Do not assume every hour in the ED harms every critically ill patient equally; the effect varied by diagnosis and hospital.
• After cardiac arrest, minimise avoidable delay to ICU or catheter lab.
• Continue ICU-level care in the ED while waiting: ventilation targets, sedation and haemodynamic monitoring.
• Record reasons for delay; they may explain more than the minutes do.

Why it matters

It challenges the simple view that ED boarding time alone drives critical care mortality.

Don't overread it

The associations were inconsistent and observational; they do not set a safe transfer-time threshold.

The statistics, in plain English

Opposite associations in two hospital types strongly suggest confounding, meaning sicker or more complex patients may wait longer for reasons that also affect survival. Observational data cannot show that faster transfer would save lives.

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