The exact strategy might vary among regions, researchers say, because local stroke organization, traffic conditions, and transportation systems differ.
It may be just as quick—or even quicker—to ship a neurointerventionalists from a comprehensive stroke center to a primary stroke center to perform mechanical thrombectomy than to ship a patient in the other direction, according to new research.
Caspar Brekenfeld, MD (University Hospital Hamburg-Eppendorf, Hamburg, Germany), and colleagues compared data on 42 stroke patients treated with mechanical thrombectomy using the “drip-and-drive” model, in which neurointerventionalists travel, with that of 32 patients managed using the “drip-and-ship” method, in which patients themselves are transferred. Their findings were published online February 7, 2018, ahead of print in the Journal of Neurosurgery.
The two groups of patients were similar with respect to median onset of symptoms to CT and time from CT to the phone call that triggered transportation. Time from CT to arrival of the transported person (either the neurointerventionalist or the patient) was longer for the drip-and-ship group, however. In addition, median time from CT to angiography was more than 2 hours longer for the drip-and-ship patients.
Time Intervals by Transportation Model: Median (IQR) Minutes
|
|
Drip and Drive (n = 42) |
Drip and Ship (n = 32) |
P Value |
|
Onset of Symptoms to CT |
88 (59-124) |
84 (67-100) |
0.896 |
|
CT to Phone |
37 (24-54) |
40 (29-54) |
0.541 |
|
CT to Arrival |
121 (108-134) |
181 (157- 219) |
< 0.001 |
|
CT to Angiography |
123 (93-147) |
252 (228–275) |
< 0.001 |
The investigators point out that the findings are “all the more astonishing as transportation of the [interventional neuroradiologist] was by taxi service whereas patients were transported by helicopter or emergency ambulance.” The physicians might be move even more quickly if they use an emergency vehicle, such as an ambulance or helicopter, Brekenfeld et al suggest.
Patients might be moving more slowly than practitioners at least in part because different services have to coordinate for their transportation and helicopters can be limited by adverse weather conditions, they say. In Germany, where the study took place, ambulances may not be permitted to leave the county district. Thus, out-of-country transportation requires the ordering of a special mobile emergency ambulance, which must frequently arrive from a fairly long distance away. In addition, delays can occur at the receiving hospital when the patient undergoes reevaluation, both clinically and by CT.
In contrast, while the interventionalist is traveling, the patient can be prepped for the intervention, they note.
“The results of our study are not applicable to every county hospital that serves as a [primary stroke center] because local stroke organization, traffic conditions, and transportation systems may be significantly different,” point out the authors. “However, our study confirms the feasibility of the ‘drip-and-drive’ concept.”
Source:
Brekenfeld C, Goebell E, Schmidt H, et al. ‘Drip-and-drive’: shipping the neurointerventionalists to provide mechanical thrombectomy in primary stroke centers. J NeuroInterv Surg. 2018;Epub ahead of print.
Disclosures:
Brekenfeld reports no relevant conflicts of interest.
