Abstract
BackgroundStroke causes death, disability and increases the use of healthcare resources worldwide. The outcome of intravenous thrombolysis and mechanical endovascular thrombectomy highly depends on the delay from symptom onset to initiation of definitive treatment. The purpose of this study was to compare the various patient transportation strategies to minimize pre-hospital delays.MethodsEmergency medical services (EMS) mission locations and ambulance response times in Finland with urgent stroke-suspected dispatch codes were collected from Emergency Response Centre (ERC) records between 1 January 2016 and 31 December 2016. Four transport scenarios were simulated for each mission, comparing ground and helicopter transportation to hospital with different treatment capabilities.ResultsIn 2016, a total of 20,513 urgent stroke-suspected missions occurred in Finland. Of these, we were able to locate and calculate a route to scenario-based hospitals in 98.7% (20,240) of the missions.For ground transport, the estimated median pre-hospital time to a thrombolysis-capable and thrombectomy-capable hospital were 54.5 min (95% confidence interval (CI), 31.7–111.4) and 94.4 min (95% CI, 33.3–195.8), respectively. Should patients be transported on the ground to thrombectomy-capable hospitals only, the pre-hospital time would increase in 11,003 (54.4%) of missions, most of which were in rural areas.With the fastest possible transportation method, the estimated mean transport time to a thrombectomy-capable hospital was 80.84 min (median, 80.80 min; 95% CI, 33.3–143.1). Helicopter transportation was the fastest method in 68.8% (13,921) of missions, and the time saved was greater than 30 min in 27.1% (5475) of missions. In rural areas, helicopter transportation was the fastest option in nearly all missions if dispatched simultaneously with ground ambulance.ConclusionHelicopter transportation may significantly decrease pre-hospital delays for stroke patients, especially in rural areas, but the selection of an optimal transportation method or chain of methods should be determined case-by-case.
Highlights
Acute ischemic stroke is the second most common cause of death worldwide [1] and results in disability for most patients and strain for healthcare services
In 2018, two studies were published that showed that thrombectomy for acute ischemic stroke was effective for up to 16 and 24 h among selected patients [8, 9]
The estimated median pre-hospital time to thrombolysis-capable and thrombectomy-capable hospitals was 54.5 min and 94.4 min, respectively
Summary
Acute ischemic stroke is the second most common cause of death worldwide [1] and results in disability for most patients and strain for healthcare services. Intravenous thrombolysis with tissue plasminogen activator (tPA) within 4.5 h after symptom onset is standard care for acute ischemic stroke. In 2018, two studies were published that showed that thrombectomy for acute ischemic stroke was effective for up to 16 and 24 h among selected patients [8, 9]. Studies have shown the efficacy, safety, and effectiveness of thrombectomy even after relatively long durations since symptom onset, the probability of good outcome is directly related to delay from symptom onset to reperfusion [10,11,12]. The outcome of intravenous thrombolysis and mechanical endovascular thrombectomy highly depends on the delay from symptom onset to initiation of definitive treatment. The purpose of this study was to compare the various patient transportation strategies to minimize pre-hospital delays
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