Abstract TMP54: Increased Thrombectomy Time Saving From Melbourne Mobile Stroke Unit Operation During Covid-19 Pandemic

Abstract

Introduction: Mobile stroke units (MSU) have demonstrated major time savings for thrombolysis but mixed evidence for endovascular thrombectomy (EVT). COVID-19 precautions have dramatically slowed EVT workflows across Australia and we therefore aimed to examine the effect of the Melbourne MSU on thrombectomy times before and during the current pandemic. Methods: Patients receiving EVT facilitated by the Melbourne MSU from 2017-2021 were compared to non-MSU patients (metropolitan direct and secondary transfer for EVT) admitted to the largest Melbourne EVT centre. Quantile regression analysis was used to calculate the median time difference (50 th quantile) between MSU and non-MSU patients before and during the pandemic, grouped by patients within an EVT centre ambulance catchment or those outside (who either received inter-hospital transfer or MSU-facilitated bypass to an EVT centre). Results: A total of 402 patients (112 MSU) were included. Pre-pandemic, no reduction in dispatch to arterial access time was seen for MSU patients within an EVT centre catchment (median 11min slower, p=0.38). However, a significant time saving was observed during the pandemic (median 29 min faster, p<0.001, p-interaction=0.0065). MSU care reduced hospital arrival to arterial access time by median 19min pre-pandemic vs 40 min during the pandemic, p-interaction<0.001). The pandemic did not alter MSU-related time savings for patients located outside of an EVT centre catchment. Conclusions: Melbourne MSU facilitation of EVT during the COVID-19 pandemic resulted in greater time savings for patients located close to a thrombectomy centre, while substantial time savings were maintained for those needing bypass from the local non-EVT hospital. This suggests that MSU operation enables streamlined EVT workflows during the pandemic by providing early pre-hospital notification and interventional angiography activation.