Department of Neurology and Neuroscience, Faculty of Medicine and Medical Center, University of Freiburg, Breisacher Str. 64, Freiburg, Germany.
Department of Emergency Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
Scand J Trauma Resusc Emerg Med. 2024 Jul 6;32(1):62. doi: 10.1186/s13049-024-01233-x.
When stroke patients with suspected anterior large vessel occlusion (aLVO) happen to live in rural areas, two main options exist for prehospital transport: (i) the drip-and-ship (DnS) strategy, which ensures rapid access to intravenous thrombolysis (IVT) at the nearest primary stroke center but requires time-consuming interhospital transfer for endovascular thrombectomy (EVT) because the latter is only available at comprehensive stroke centers (CSC); and (ii) the mothership (MS) strategy, which entails direct transport to a CSC and allows for faster access to EVT but carries the risk of IVT being delayed or even the time window being missed completely. The use of a helicopter might shorten the transport time to the CSC in rural areas. However, if the aLVO stroke is only recognized by the emergency service on site, the helicopter must be requested in addition, which extends the prehospital time and partially negates the time advantage. We hypothesized that parallel activation of ground and helicopter transportation in case of aLVO suspicion by the dispatcher (aLVO-guided dispatch strategy) could shorten the prehospital time in rural areas and enable faster treatment with IVT and EVT.
As a proof-of-concept, we report a case from the LESTOR trial where the dispatcher suspected an aLVO stroke during the emergency call and dispatched EMS and HEMS in parallel. Based on this case, we compare the provided aLVO-guided dispatch strategy to the DnS and MS strategies regarding the times to IVT and EVT using a highly realistic modeling approach.
With the aLVO-guided dispatch strategy, the patient received IVT and EVT faster than with the DnS or MS strategies. IVT was administered 6 min faster than in the DnS strategy and 22 min faster than in the MS strategy, and EVT was started 47 min earlier than in the DnS strategy and 22 min earlier than in the MS strategy.
In rural areas, parallel activation of ground and helicopter emergency services following dispatcher identification of stroke patients with suspected aLVO could provide rapid access to both IVT and EVT, thereby overcoming the limitations of the DnS and MS strategies.
当疑似前大血管闭塞（aLVO）的中风患者恰好居住在农村地区时，有两种主要的院前转运选择：（i）滴注-转运（DnS）策略，该策略可确保在最近的初级卒中中心快速接受静脉溶栓治疗（IVT），但需要耗时的院内转运进行血管内血栓切除术（EVT），因为后者仅在综合卒中中心（CSC）提供；（ii）母舰（MS）策略，该策略需要直接转运到 CSC，并允许更快地接受 EVT，但存在 IVT 延迟甚至完全错过时间窗的风险。在农村地区使用直升机可能会缩短转运到 CSC 的时间。然而，如果仅在现场的急救服务识别出 aLVO 中风，还必须请求直升机，这会延长院前时间，并在一定程度上抵消时间优势。我们假设，在调度员怀疑存在 aLVO 时（aLVO 引导调度策略）平行激活地面和直升机转运，可能会缩短农村地区的院前时间，并能够更快地进行 IVT 和 EVT 治疗。
作为概念验证，我们报告了 LESTOR 试验中的一个病例，在该病例中，调度员在紧急呼叫期间怀疑发生 aLVO 中风，并平行调度了 EMS 和 HEMS。基于该病例，我们使用高度现实的建模方法，比较了 aLVO 引导调度策略与 DnS 和 MS 策略在 IVT 和 EVT 时间方面的差异。
使用 aLVO 引导调度策略，患者接受 IVT 和 EVT 的速度比 DnS 或 MS 策略更快。IVT 给药时间比 DnS 策略快 6 分钟，比 MS 策略快 22 分钟，EVT 开始时间比 DnS 策略早 47 分钟，比 MS 策略早 22 分钟。
在农村地区，在调度员识别出疑似 aLVO 的中风患者后，平行激活地面和直升机紧急服务，可以快速获得 IVT 和 EVT，从而克服 DnS 和 MS 策略的局限性。
