A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study
Abstract Background Mechanical thrombectomy is the treatment of choice for large vessel occlusion strokes done only in comprehensive stroke centres (CSC). We investigated whether the transportation time of thrombectomy candidates from another hospital district could be reduced by using an ambulance...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-024-00931-0 |
| _version_ | 1797276712706244608 |
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| author | Pauli Vuorinen Piritta Setälä Jyrki Ollikainen Sanna Hoppu |
| author_facet | Pauli Vuorinen Piritta Setälä Jyrki Ollikainen Sanna Hoppu |
| author_sort | Pauli Vuorinen |
| collection | DOAJ |
| description | Abstract Background Mechanical thrombectomy is the treatment of choice for large vessel occlusion strokes done only in comprehensive stroke centres (CSC). We investigated whether the transportation time of thrombectomy candidates from another hospital district could be reduced by using an ambulance and a helicopter and how this affected their recovery. Methods We prospectively gathered the time points of thrombectomy candidates referred to the Tampere University Hospital from the hospital district of Southern Ostrobothnia. Primary and secondary transports were included. In Hybrid transport, the helicopter emergency medical services (HEMS) unit flew from an airport near the CSC to meet the patient during transport and continued the transport to definitive care. Ground transport was chosen only when the weather prevented flying, or the HEMS crew was occupied in another emergency. We contacted the patients treated with mechanical thrombectomy 90 days after the intervention and rated their recovery with the modified Rankin Scale (mRS). Favourable recovery was considered mRS 0–2. Results During the study, 72 patients were referred to the CSC, 71% of which were first diagnosed at the PSC. Hybrid transport (n = 34) decreased the median time from the start of transport from the PSC to the computed tomography (CT) at the CSC when compared to Ground (n = 17) transport (84 min, IQR 82–86 min vs. 109 min, IQR 104–116 min, p < 0.001). The transport times straight from the scene to CT at the CSC were equal: median 93 min (IQR 80–102 min) in the Hybrid group (n = 11) and 97 min (IQR 91–108 min) in the Ground group (n = 10, p = 0.28). The percentages of favourable recovery were 74% and 50% in the Hybrid and Ground transport groups (p = 0.38) from the PSC. Compared to Ground transportation from the scene, Hybrid transportation had less effect on the positive recovery percentages of 60% and 50% (p = 1.00), respectively. Conclusion Adding a HEMS unit to transporting a thrombectomy candidate from a PSC to CSC decreases the transport time compared to ambulance use only. This study showed minimal difference in the recovery after thrombectomy between Hybrid and Ground transports. |
| first_indexed | 2024-03-07T15:32:10Z |
| format | Article |
| id | doaj.art-e584eabaaa034f078ec3015046c934a1 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-03-07T15:32:10Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-e584eabaaa034f078ec3015046c934a12024-03-05T16:21:59ZengBMCBMC Emergency Medicine1471-227X2024-01-012411910.1186/s12873-024-00931-0A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational studyPauli Vuorinen0Piritta Setälä1Jyrki Ollikainen2Sanna Hoppu3Emergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa wellbeing services countyEmergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa wellbeing services countyDepartment of Neurosciences and Rehabilitation, Tampere University HospitalEmergency Medical Services, Centre for Prehospital Emergency Care, Pirkanmaa wellbeing services countyAbstract Background Mechanical thrombectomy is the treatment of choice for large vessel occlusion strokes done only in comprehensive stroke centres (CSC). We investigated whether the transportation time of thrombectomy candidates from another hospital district could be reduced by using an ambulance and a helicopter and how this affected their recovery. Methods We prospectively gathered the time points of thrombectomy candidates referred to the Tampere University Hospital from the hospital district of Southern Ostrobothnia. Primary and secondary transports were included. In Hybrid transport, the helicopter emergency medical services (HEMS) unit flew from an airport near the CSC to meet the patient during transport and continued the transport to definitive care. Ground transport was chosen only when the weather prevented flying, or the HEMS crew was occupied in another emergency. We contacted the patients treated with mechanical thrombectomy 90 days after the intervention and rated their recovery with the modified Rankin Scale (mRS). Favourable recovery was considered mRS 0–2. Results During the study, 72 patients were referred to the CSC, 71% of which were first diagnosed at the PSC. Hybrid transport (n = 34) decreased the median time from the start of transport from the PSC to the computed tomography (CT) at the CSC when compared to Ground (n = 17) transport (84 min, IQR 82–86 min vs. 109 min, IQR 104–116 min, p < 0.001). The transport times straight from the scene to CT at the CSC were equal: median 93 min (IQR 80–102 min) in the Hybrid group (n = 11) and 97 min (IQR 91–108 min) in the Ground group (n = 10, p = 0.28). The percentages of favourable recovery were 74% and 50% in the Hybrid and Ground transport groups (p = 0.38) from the PSC. Compared to Ground transportation from the scene, Hybrid transportation had less effect on the positive recovery percentages of 60% and 50% (p = 1.00), respectively. Conclusion Adding a HEMS unit to transporting a thrombectomy candidate from a PSC to CSC decreases the transport time compared to ambulance use only. This study showed minimal difference in the recovery after thrombectomy between Hybrid and Ground transports.https://doi.org/10.1186/s12873-024-00931-0Helicopter emergency medicine serviceLarge vessel occlusion strokeMechanical thrombectomy |
| spellingShingle | Pauli Vuorinen Piritta Setälä Jyrki Ollikainen Sanna Hoppu A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study BMC Emergency Medicine Helicopter emergency medicine service Large vessel occlusion stroke Mechanical thrombectomy |
| title | A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study |
| title_full | A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study |
| title_fullStr | A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study |
| title_full_unstemmed | A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study |
| title_short | A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study |
| title_sort | hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care a prospective observational study |
| topic | Helicopter emergency medicine service Large vessel occlusion stroke Mechanical thrombectomy |
| url | https://doi.org/10.1186/s12873-024-00931-0 |
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