Shift from drip-and-ship towards mothership model for mechanical thrombectomy during COVID-19 pandemic: A retrospective analysis of a stroke network performances

Abstract

The choice between transport of acute ischemic stroke patients to the nearest Primary Stroke Centers (drip-and-ship model) versus direct transport to the Comprehensive Stroke Center (mothership model) is still a matter of debate. We shifted from a drip-and-ship towards a mothership model during the first wave of COVID-19 pandemic in spring 2020. We retrospective analyzed stroke network performances comparing the two models. All spoke-district patients treated with endovascular thrombectomy (EVT) between 15th March – 15th June 2019 (drip-and-ship) and 2020 (mothership) were included in the study. We compared call-to-door time (CDT), door-to-CT time (DCT), door-to-needle time (DNT), door-to-groin time (DGT), call-to-needle time (CNT) and call-to-groin time (CGT) between the two periods. We also compared functional independence (modified Rankin Scale, mRS) at 3 months. 24 spoke-district patients in 2019 (drip-and-ship) and 26 in 2020 (mothership) underwent EVT. In 2020 a higher number of patients received IV thrombolysis in combination with EVT (p = .030). The groups did not differ for age, sex, risk factors, pre-stroke mRS 0-1, NIHSS and ASPECTS distribution. In 2020 we found longer CDT (+23 min, p < .005), but shorter DCT (−11.5 min, p = .017), DNT (−20.5 min, p = .001), and DGT (−78 min, p < .005). Overall, in 2020 we found a significant decrease in CGT time (−55.5 min, p < .005) without significant differences in CNT (p = .324). We found no effects of the stroke network model on the 3 month mRS (shift analysis, p = .241; mRS categories 0–1 vs 2–6, p = .706). The mothership model guaranteed quicker EVT without significantly delaying IVT.