PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：当疑似前大血管闭塞（aLVO）的中风患者碰巧生活在农村地区时，院前运输有两个主要选择：(I)滴灌和装运(DNS)策略，这确保了在最近的主要卒中中心快速获得静脉溶栓（IVT），但需要耗时的院间转院进行血管内血栓切除术（EVT），因为后者仅在综合卒中中心（CSC）可用；和（ii）母体（MS）策略，这需要直接运输到CSC，并允许更快地访问EVT，但存在IVT延迟甚至完全错过时间窗口的风险。使用直升机可能会缩短到农村地区CSC的运输时间。然而,如果aLVO中风仅由现场紧急服务人员识别，此外，必须要求直升机，这延长了院前时间，部分抵消了时间优势。我们假设，在调度员怀疑LVO的情况下，平行激活地面和直升机运输（LVO指导的调度策略）可以缩短农村地区的院前时间，并可以更快地使用IVT和EVT进行治疗。
方法：作为概念证明，我们报告了LESTOR试验中的一例病例,其中调度员在紧急呼叫期间怀疑发生了aLVO卒中,并并行派遣了EMS和HEMS.基于这个案子,我们使用高度现实的建模方法，将提供的aLVO指导的调度策略与DnS和MS策略关于IVT和EVT的时间进行了比较。
结果：使用aLVO指导的调度策略，与DnS或MS策略相比,患者接受IVT和EVT的速度更快.IVT比DnS策略快6分钟，比MS策略快22分钟，EVT比DnS策略早47分钟，比MS策略早22分钟。
结论：在农村地区，在调度员识别出疑似aLVO的中风患者后，平行启动地面和直升机急救服务，可以快速进入IVT和EVT，从而克服了DnS和MS策略的局限性。
方法：作为概念证明，我们报告了LESTOR试验中的一例病例,其中调度员在紧急呼叫期间怀疑发生了aLVO卒中,并并行派遣了EMS和HEMS.基于这个案子,我们使用高度现实的建模方法，将提供的aLVO指导的调度策略与DnS和MS策略关于IVT和EVT的时间进行了比较。
结果：使用aLVO指导的调度策略，与DnS或MS策略相比,患者接受IVT和EVT的速度更快.IVT比DnS策略快6分钟，比MS策略快22分钟，EVT比DnS策略早47分钟，比MS策略早22分钟。
结论：在农村地区，在调度员识别出疑似aLVO的中风患者后，平行启动地面和直升机急救服务，可以快速进入IVT和EVT，从而克服了DnS和MS策略的局限性。
