University of California, San Diego, La Jolla, CA.
University of California, San Diego, La Jolla, CA.
Air Med J. 2020 Mar-Apr;39(2):103-106. doi: 10.1016/j.amj.2019.10.003. Epub 2019 Nov 1.
Embolectomy is standard for select occlusions up to 24 hours. Transfer patients may have worse outcomes than those originating in embolectomy centers. We developed the Brain Emergency Management Initiative (BEMI) protocol to streamline this transfer process and mimic the urgency that surrounds ST-elevation myocardial infarction cardiac evaluations.
We conducted an exploratory assessment of consecutive acute telestroke patients transferred for potential intervention in pre-BEMI versus BEMI periods. Times included spoke in, spoke out, hub in, and groin puncture. Outcomes included discharge destination and symptomatic intracranial hemorrhage.
Overall, 68 transfers were assessed. There was a higher National Institute of Neurological Disorders and Stroke in BEMI (11 pre-BEMI vs. 20 B.M., P = .01). There were shorter spoke door in to door out (143 vs. 118 minutes, P = .01) and spoke door out to hub door in times (23 minutes pre-BEMI vs. 21 minutes BEMI, P = .001). For embolectomy patients, there was shorter hub door in to reperfusion (83 minutes pre-BEMI vs. 74 minutes BEMI, P = .04) and recombinant tissue plasminogen decision to groin puncture (155 minutes pre-BEMI vs. 130 minutes BEMI; P = .01). There were no symptomatic intracranial hemorrhage or discharge differences.
In our hub-helicopter emergency medical services-spoke telestroke network, BEMI led to improved evaluation times. BEMI may serve as a model for future rapid stroke transfer pathways.
取栓术是治疗 24 小时内特定闭塞的标准方法。转院患者的预后可能比那些来自取栓中心的患者差。我们制定了脑急救管理倡议（BEMI）方案，以简化这一转移过程，并模拟 ST 段抬高型心肌梗死心脏评估所带来的紧迫性。
我们对连续急性远程脑卒中患者进行了探索性评估，这些患者在 BEMI 之前和之后的时间段内接受了潜在的介入治疗。时间包括入站时间、出站时间、中心入站时间和腹股沟穿刺时间。结果包括出院目的地和症状性颅内出血。
总体而言，评估了 68 例转院患者。BEMI 组的国立神经疾病与卒中研究所评分更高（11 例 BEMI 与 20 例 B.M.，P=0.01）。入站到出站的时间更短（143 分钟与 118 分钟，P=0.01），出站到中心入站的时间更短（23 分钟 BEMI 与 21 分钟 BEMI，P=0.001）。对于取栓患者，中心入站到再灌注的时间更短（83 分钟与 74 分钟，P=0.04），重组组织纤溶酶原激活物决定腹股沟穿刺的时间更短（155 分钟与 130 分钟，P=0.01）。没有症状性颅内出血或出院差异。
在我们的中心-直升机-急救医疗服务-远程脑卒中网络中，BEMI 导致评估时间的改善。BEMI 可能成为未来快速脑卒中转移途径的模型。
