We report the detection of 376.05 Hz (2.66 ms) coherent X-ray pulsations in NICER observations of a transient outburst of the low-mass X-ray binary IGR J17494-3030 in 2020 October/November. The system is an accreting millisecond X-ray pulsar in a 75 minute ultracompact binary. The mass donor is most likely a $simeq 0.02 M_odot$ finite-entropy white dwarf composed of He or C/O. The fractional rms pulsed amplitude is 7.4%, and the soft (1-3 keV) X-ray pulse profile contains a significant second harmonic. The pulsed amplitude and pulse phase lag (relative to our mean timing model) are energy-dependent, each having a local maximum at 4 keV and 1.5 keV, respectively. We also recovered the X-ray pulsations in archival 2012 XMM-Newton observations, allowing us to measure a long-term pulsar spin-down rate of $dot u = -2.1(7)times10^{-14}$ Hz/s and to infer a pulsar surface dipole magnetic field strength of $simeq 10^9$ G. We show that the mass transfer in the binary is likely non-conservative, and we discuss various scenarios for mass loss from the system.