Department of Neurosurgery, The Mount Sinai Hospital, New York, New York, USA,
Department of Neurosurgery, The Mount Sinai Hospital, New York, New York, USA.
Cerebrovasc Dis Extra. 2021;11(3):137-144. doi: 10.1159/000520078. Epub 2021 Nov 25.
The aim of the study was to model the effect of prehospital triage of emergent large vessel occlusion (ELVO) to endovascular capable center (ECC) on the timing of thrombectomy and intravenous (IV) thrombolysis using real-world data from a multihospital system.
We selected a cohort of 77 consecutive stroke patients who were brought by emergency medical services (EMS) to a nonendovascular capable center and then transferred to an ECC for mechanical thrombectomy (MT) ("actual" drip and ship [DS] cohort). We created a hypothetical scenario (bypass model [BM]), modeling transfer of the patients directly to an ECC, based on patients' initial EMS pickup address and closest ECC. Using another cohort of 73 consecutive patients, who were brought directly to an ECC by EMS and underwent endovascular intervention, we calculated mean door-to-needle and door-to-arterial puncture (AP) times ("actual" mothership [MS] cohort). Timings in the actual MS cohort and the actual DS cohort were compared to timings from the BM cohort.
Median first medical contact (FMC) to IV thrombolysis time was 87.5 min (interquartile range [IQR] = 38) for the DS versus 78.5 min (IQR = 8.96) for the BM cohort, with p = 0.1672. Median FMC to AP was 244 min (IQR = 97) versus 147 min (IQR = 8.96) (p < 0.001), and median FMC to TICI 2B+ time was 299 min (IQR = 108.5) versus 197 min (IQR = 8.96) (p < 0.001) for the DS versus BM cohort, respectively.
Modeled EMS prehospital triage of ELVO patients' results in shorter MT times without a change in thrombolysis times. As triage tools increase in sensitivity and specificity, EMS triage protocols stand to improve patient outcomes.
本研究旨在使用多医院系统的真实数据，通过模型研究将急诊大血管闭塞（ELVO）患者分诊到血管内治疗能力中心（ECC）对血栓切除术和静脉（IV）溶栓时间的影响。
我们选择了 77 例连续的卒中患者队列，这些患者由紧急医疗服务（EMS）送往非血管内治疗能力中心，然后转至 ECC 进行机械血栓切除术（MT）（“实际”滴注和转运[DS]队列）。我们根据患者的初始 EMS 接送地址和最近的 ECC 创建了一个假设场景（旁路模型[BM]），模拟将患者直接转运至 ECC。我们还使用了另一组 73 例连续患者的队列，这些患者由 EMS 直接送往 ECC 并接受血管内介入治疗，计算了平均门到针和门到动脉穿刺（AP）时间（“实际”母舰[MS]队列）。实际 MS 队列和实际 DS 队列的时间与 BM 队列的时间进行了比较。
DS 队列的首次医疗接触（FMC）到 IV 溶栓时间中位数为 87.5 分钟（IQR = 38），BM 队列为 78.5 分钟（IQR = 8.96），p = 0.1672。FMC 到 AP 的中位数为 244 分钟（IQR = 97），BM 队列为 147 分钟（IQR = 8.96）（p < 0.001），FMC 到 TICI 2B+的中位数时间为 299 分钟（IQR = 108.5），BM 队列为 197 分钟（IQR = 8.96）（p < 0.001）。
经模型模拟的 EMT 对 ELVO 患者的院前分诊结果导致 MT 时间缩短，而溶栓时间不变。随着分诊工具的敏感性和特异性的提高，EMS 分诊方案有望改善患者的预后。
