Article • Acute cardiovascular care
Saving lives with timely transfers to cardiac arrest centres
Networks of certified cardiac arrest centres could dramatically improve survival and neurological outcomes for patients who suffer out-of-hospital cardiac arrest. At the ESC 2026 congress in Munich, experts debated how hub-and-spoke models in acute cardiovascular care can standardise treatment – not only for cardiac arrest, but also for pulmonary embolism and cardiogenic shock.
By Mark Nicholls
Sudden cardiac death remains the third leading cause of death in Europe, with an estimated annual incidence of out-of-hospital cardiac arrest (OHCA) ranging from 67 to 170 cases per 100,000 people. Overall survival remains poor – at 10% or lower. Yet in European hospitals that can implement withdrawal of life-sustaining therapy, more than 90% of patients who survive to hospital discharge have a favourable neurological outcome.
‘However, neurological impairment, fatigue and emotional difficulties are common,’ said Professor Alessandro Sionis, the newly elected president of the Association for Acute Cardiovascular Care (ACVC), speaking at a dedicated session on fast transfers and the hub-and-spoke model.
Marked differences between centres
Sionis, a consultant cardiologist at the Hospital de la Santa Creu i Sant Pau in Barcelona, Spain, identified 'substantial variability' across cardiac arrest centres (CACs) that is still negatively affecting the quality of care. He pointed to 'marked' centre-to-centre differences in outcomes after OHCA, which appear to be ‘partly attributable to variations in in-hospital management strategies and post-resuscitation care.’1
A joint survey by the ACVC, the European Society of Emergency Medicine (EUSEM) and the European Society of Intensive Care Medicine (ESICM) on OHCA practices revealed ‘huge variations among European hospitals’ – but also showed that cardiac arrest centres ‘appear to have a higher compliance with guidelines compared with other centres.’2
‘A network of certified CACs is more likely to ensure that standardised high quality bundled care is equally and equitably promoted for all patients,’ Sionis stated. ‘We have some emerging observational evidence that associates CAC care and certification with improved neurological outcomes.’
What cardiac arrest centres need
According to Sionis, CACs should have minimum requirements of a 24/7 on-site coronary angiography lab, an emergency department, and an ICU with echocardiography, CT and MRI imaging – providing comprehensive care through integrated multidisciplinary teams and multimodal neuro-prognostication.3
Clear protocols should also be in place for transferring patients to OHCA hub hospitals, which should offer expanded diagnostics and treatment including extracorporeal cardiopulmonary resuscitation (ECPR), arrhythmia management and electrophysiological device therapy. However, patients still arrive at different hospitals through different pathways – a challenge that remains to be addressed.
Sionis pointed to the latest guidelines from the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR), which recommend that OHCA patients should be cared for in a dedicated cardiac arrest centre and that healthcare systems should establish cardiac arrest networks with clear protocols and certification.
From Germany to Spain: certification gains momentum
Certification is not an endpoint: it is a means to implement a quality improvement process that requires continuous measurement, benchmarking, audit, and reassessment
Alessandro Sionis
In Germany, accredited CACs have been evolving since 2015, with the 250th certification recently achieved.4 In Spain, the CAPAC Project for CACs aims to promote high-quality clinical practices with a multidisciplinary team approach and enhanced coordination between hospitals.
‘Certification is not an endpoint: it is a means to implement a quality improvement process that requires continuous measurement, benchmarking, audit, and reassessment – with the ultimate objective of providing timely access to the right level of post-resuscitation care to all of our patients,’ Sionis added.
‘A potential advantage for healthcare systems is that they will eventually save money, besides the main objective which is to save lives and improve neurological prognosis.’
Pulmonary embolism: who to transfer and when
Professor Cecilia Becattini from the University of Perugia in Italy discussed the value of spoke-and-hub care for intermediate and high-risk pulmonary embolism (PE) patients.
‘The crucial question is: who are the patients who should be transferred and when,’ said Becattini, a world expert on PE who co-chairs the new ESC PE guidelines to be released next year.
Outlining the rationale for hub-and-spoke models in acute PE, she pointed to data collected between 2006 and 2019 showing that deaths were higher in rural hospitals compared to those in metropolitan areas.5 Stating that acute PE is a highly heterogeneous clinical condition, she emphasised the importance of identifying patients that may benefit from centralisation – but warned that expertise and timing matter.6
Becattini also said clinicians should consider stabilisation of patients before transfer to a specialist centre, starting treatment and anticoagulation first, but always balancing the benefits and the risks.7
Cardiogenic shock: when rapid transfer is essential
Professor Christian Hassager from Copenhagen University Hospital in Denmark focused on the needs of cardiogenic shock patients. He said that once shock has developed, mortality is very high – meaning those patients may need rapid transfer to a specialist centre.8
Profiles:
Professor Alessandro Sionis is a consultant cardiologist and director of the Acute and Intensive Cardiac Care Unit at the Hospital de la Santa Creu i Sant Pau in Barcelona, and Professor of Cardiology at the Universitat Autònoma de Barcelona, Spain. He is the newly elected President of the ACVC. His research interests focus on chest pain, acute heart failure and critical care cardiology.
Professor Cecilia Becattini is Professor of Internal Medicine at the University of Perugia, Italy, and works at the Internal and Cardiovascular Medicine and Stroke Unit of the University Hospital in Perugia. A world expert on pulmonary embolism, she co-chairs the ESC PE guidelines group and is involved in research on the prevention, diagnosis and treatment of venous thromboembolism and atrial fibrillation.
Professor Christian Hassager is a cardiologist and Professor at Copenhagen University and Rigshospitalet, Copenhagen, Denmark. He is a former director of the cardiology intensive care unit at Rigshospitalet and a past president of both the ACVC and the Danish Society of Cardiology. He is currently Chair of the Danish Heart Foundation. His research focuses on cardiogenic shock and post-resuscitation care after cardiac arrest.
References:
- May TL, Lary CW, Riker RR, et al. Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. Intensive Care Med. 2019;45(5):637-646. doi:10.1007/s00134-019-05580-7
- Jorge-Perez P, Nikolaou N, Donadello K, et al. Management of comatose survivors of out-of-hospital cardiac arrest in Europe: current treatment practice and adherence to guidelines. A joint survey by the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Resuscitation Council (ERC), the European Society for Emergency Medicine (EUSEM), and the European Society of Intensive Care Medicine (ESICM). Eur Heart J Acute Cardiovasc Care. 2023;12(2):96-105. doi:10.1093/ehjacc/zuac153
- Sinning C, Ahrens I, Cariou A, et al. The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause - aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM). Eur Heart J Acute Cardiovasc Care. 2020;9(4_suppl):S193-S202. doi:10.1177/2048872620963492
- Rott N, Busch HJ, Frey N, et al. Letter to the Editor: 250th cardiac arrest center certification in Germany. Clin Res Cardiol. Published online October 13, 2025. doi:10.1007/s00392-025-02777-3
- Zghouzi M, Mwansa H, Shore S, et al. Sex, Racial, and Geographic Disparities in Pulmonary Embolism-related Mortality Nationwide. Ann Am Thorac Soc. 2023;20(11):1571-1577. doi:10.1513/AnnalsATS.202302-091OC
- Becattini C, Vedovati MC, Colombo S, et al. Identification of hemodynamically stable patients with acute pulmonary embolism at high risk for death: external validation of different models. J Thromb Haemost. 2024;22(9):2502-2513. doi:10.1016/j.jtha.2024.04.025
- Writing Committee Members, Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415
- Frydland M, Møller JE, Lindholm MG, et al. Biomarkers predictive of late cardiogenic shock development in patients with suspected ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2020;9(6):557-566. doi:10.1177/2048872619896063
16.09.2026
