Objective Expeditious interhospital transport of patients with potential large-vessel occlusions is key in the hub and spoke model, where patients are first taken to a local primary hospital to be evaluated for intravenous thrombolysis, and then subsequently transferred to an endovascular capable stroke center. The decision on transport modality—air versus ground transportation—may be multifactorial, dependent upon dispatch times, availability, and cost. This study aims to evaluate and quantify the presumed reduction in time to thrombectomy with air compared to ground transport.
Methods Patients undergoing mechanical thrombectomy for carotid circulation occlusion within 6 hours at an urban, comprehensive stroke center were retrospectively analyzed. Multivariable linear regression evaluated the relationship between transport modality and the time from last known well to groin puncture after adjusting for distance from the comprehensive stroke center.
Results From January 2015 to March 2018, 133 mechanical thrombectomy interhospital transfers were identified; transportation modality was air in 30.8% (n=41) and ground in 69.2% (n=92). The mean inter-hospital distance was 24.1 (standard deviation 16.4, range 0–62) miles. Among patients travelling greater than 10 miles, the use of air transport was associated with a significantly shorter time between last known well and groin puncture when compared to ground (by 26.3 minutes, 95% CI: 1.1–51.9 minutes, p=0.04). The benefit of air transport was greater with increasing distances, with a significantly shorter time to thrombectomy of 35.1 minutes (p=0.02) if an inter-hospital distance of greater than 20 miles, and of 42.2 minutes (p=0.03) if greater than 30 miles. Within 10 miles however, all patients were transported by ground.
Conclusions In this single-center analysis, helicopter emergency medical service lead to a shorter time to thrombectomy compared with ground transport. Given the known benefit to earlier revascularization on stroke outcomes, these data support the use of emergency aeromedical services when logistically feasible for stroke thrombectomy interhospital transfers greater than 10 miles.
Disclosures H. Dasenbrock: None. A. Beer-Furlan: None. A. Vargas: None. J. Connors: None. R. Crowley: None. M. Chen: 2; C; Genentech, Pneumbra, Stryker, Medtronic.
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