Effect of helicopter transport on neurological outcomes in a mouse model of embolic stroke with reperfusion: AIR-MICE pilot study

Leira, Enrique C.; Zaheer, Asgar; Schnell, Thomas; Torner, James C.; Olalde, Heena; Pieper, Andrew A.; Ortega‐Gutiérrez, Santiago; Nagaraja, Nandakumar; Marks, Nancy; Adams, Harold P.

doi:10.1111/ijs.12619

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…Transport by helicopter has been reported to be safe in animal experimental models as well as in human patients with stroke. 18–20) Currently, we use a 24-h helicopter transportation system consisting of three types of helicopter: HEMS, an MSDF helicopter, and an FDP helicopter. Helicopter transport from the islands to our hospital using an MSDF helicopter was started in the 1970s.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

Hiu

Ozono

Kawahara

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Our hospital, located on the mainland, serves as a hub center for nine hospitals on the remote islands of Nagasaki Prefecture, Japan. There are no stroke specialists on these islands. We can transfer emergency patients from these islands to our hospital at any time, using a teleradiology system and three types of helicopter transport. We examined the efficacy of the drip and ship (DS) method for treating patients with acute ischemic stroke (AIS) on these islands, in comparison with patients on the mainland. From 2010 to 2017, we reviewed 98 consecutive patients with AIS who received intravenous recombinant tissue plasminogen activator (IV rt-PA) in our hospital or were transported to our hospital after IV rt-PA. Patients were divided into the Islands group (received IV rt-PA on the islands, DS; 31 cases) and the Mainland group (67 cases). The median transport distance from the islands was 112 km. The rate of patients achieving favorable outcomes was 54.8% in the Islands group and 64.2% in the Mainland group, with no significant differences. Multivariate analysis revealed that patients living on isolated islands did not have increased risks of unfavorable outcomes. Endovascular therapy (EVT), as part of the drip, ship, and retrieve method, was performed in 22.6% of patients in the Islands group and EVT in 38.8% of those in the Mainland group. The DS method seems feasible and safe for patients living on isolated islands with the use of 24-h helicopter transportation and teleradiology.

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Section: Discussionmentioning

confidence: 99%

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

Hiu

Ozono

Kawahara

et al. 2019

Neurol. Med. Chir.(Tokyo)

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“…For example, low-frequency vibration may lead to an increase in blood-brain barrier permeability or the hypobaric environment may worsen the ischemic penumbra. 16,17 However, some of the environmental factors could be beneficial for the thrombus. 17 The accelerations and low frequency vibrations associated with HEMs transfer may be synergistic with rtPA and enhance the thrombolysis effectiveness of rtPA.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 However, some of the environmental factors could be beneficial for the thrombus. 17 The accelerations and low frequency vibrations associated with HEMs transfer may be synergistic with rtPA and enhance the thrombolysis effectiveness of rtPA. 18,19 The vibration effects in conjunction with thrombolysis have been shown to increase the rate of recanalization compared to thrombolysis alone.…”

Section: Discussionmentioning

confidence: 99%

Helicopter “Drip and Ship” Flights Do Not Alter the Pharmacological Integrity of rtPA

Faine

Dayal

Kumar

et al. 2018

Journal of Stroke and Cerebrovascular Diseases

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“…A randomized pilot study on a murine embolic model suggested that helicopter transport did not negatively influence outcomes, and in fact the trend was towards smaller infarctions and hemorrhage. 42 Clearly, the potential influence of HEMS physical factors on stroke outcomes needs to be studied further. It is crucial to understand the net effect and interaction of those physical factors in order to optimize the delivery of thrombolytic agents, best medical care, and eventual neuroprotective agents, for drip and ship stroke patients.…”

Section: Physical Factor Potential Effectmentioning

confidence: 99%

“…It is crucial to understand the net effect and interaction of those physical factors in order to optimize the delivery of thrombolytic agents, best medical care, and eventual neuroprotective agents, for drip and ship stroke patients. 42 Current ancillary care in patients transported through HEMS…”

Section: Physical Factor Potential Effectmentioning

confidence: 99%

Helicopter transportation in the era of thrombectomy: The next frontier for acute stroke treatment and research

Leira

Stilley

Schnell

et al. 2016

European Stroke Journal

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Purpose: Many patients suffer a stroke at a significant distance from a specialized center capable of delivering endovascular therapy. As a result, they require rapid transport by helicopter emergency medical services, sometimes while receiving a recombinant tissue plasminogen activator infusion (drip and ship). Despite its critical role in the new era of reperfusion, helicopter emergency medical services remains a poorly evaluated aspect of stroke care. Method: Comprehensive narrative review of all published articles of helicopter emergency medical services related to acute stroke care in the inter-hospital and pre-hospital settings, including technical aspects and physical environment implications. Findings: Helicopter emergency medical services transports are conducted during a critical early time period when specific interventions and ancillary care practices may have a significant influence on outcomes. We have limited knowledge of the potential impact of the unusual physical factors generated by the helicopter on the ischemic brain, which affects our ability to establish rational guidelines for ancillary care and the delivery of specific interventions. Discussion: Unlike the pre-hospital and hospital settings where stroke interventions are delivered, the inter-hospital helicopter emergency medical services transfer setting remains a ''black box'' for acute stroke care and research. This gap is particularly relevant for many patients living in rural areas, or in congested urban areas, that depend on helicopter emergency medical services for rapid access to a tertiary stroke center. Conclusion: Addressing the helicopter emergency medical services stroke gap in clinical trials and acute care delivery would homogenize capabilities through all care settings, thus minimizing potential disparities in research access and outcomes based on geographical location.

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Effect of helicopter transport on neurological outcomes in a mouse model of embolic stroke with reperfusion: AIR-MICE pilot study

Cited by 6 publications

References 21 publications

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

Helicopter “Drip and Ship” Flights Do Not Alter the Pharmacological Integrity of rtPA

Helicopter transportation in the era of thrombectomy: The next frontier for acute stroke treatment and research

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