A university-based cardiac transport system was developed for the safe transfer of critically ill cardiac patients from community hospitals to a tertiary care facility. During the first year of operation, 50 patients were transported, 41 (82%) by ambulance and 9 (18%) by helicopter, from 24 hospitals in four New England states. The average response time from hospital request to transport team arrival was 75 minutes. Seventy-eight percent of these patients were unstable at the time of transfer. Hypotension or cardiogenic shock (39%), ventricular tachycardia or fibrillation (16%), and severe and recurrent chest pain (12%) were the most common conditions for which the team was summoned. Forty-six percent required invasive procedures for stabilization prior to transport, and one-third of patients required active intervention, including defibrillation, during transfer to the tertiary care facility. The majority (62%) of transferred patients underwent significant hospital procedures, and 75% of admitted patients were discharged from the hospital. Our initial experience indicates that transport of critically ill cardiac patients in need of advanced care can be accomplished in a rapid and efficient manner with a relatively good short-term prognosis.