New Prehospital Triage for Stroke Patients Significantly Reduces Transport Time of EVT Patients Without Delaying IVT

Abstract

Background and Purpose: Ischemic stroke is a leading cause of mortality and morbidity worldwide. The time from stroke onset to treatment impacts clinical outcome. Here, we examined whether changing a triage model from “drip and ship” to “mothership” yielded significant reductions of onset-to-groin time (OGT) in patients receiving EVT and onset-to-needle time (ONT) in IVT-treated patients, compared to before FAST-PLUS test implementation. We also investigated whether the new triage improved clinical outcomes.Methods: In a before/after multicenter study, we evaluated the effects of changing the prehospital triage system for suspected stroke patients in the Moravian–Silesian region, Czech Republic. In the new system, the validated FAST PLUS test is used to differentiate patients with suspected large vessel occlusion and triage-positive patients are transported directly to the CSC. Time metrics and patient data were obtained from the regional EMS database and SITS database.Results: For EVT patients, the median OGT was 213 min in 2015 and 142 min in 2018, and the median TT was 142 min in 2015 and 47 min in 2018. For tPA patients, the median ONT was 110 min in 2015 and 109 min in 2018, and the median TT was 41 min in 2015 and 48 min in 2018. Clinical outcome did not significantly change. The percentages of patients with favorable clinical outcome (mRS 0–2) were comparable between 2015 and 2018: 60 vs. 59% in tPA patients and 40 vs. 44% in EVT patients.Conclusions: The new prehospital triage has yielded shorter OGTs for EVT patients. No changes were found in the onset-to-needle time for IVT-treated patients, or in the clinical outcome at 3 months after stroke onset.

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

“…Despite many efforts to speed up and optimise acute stroke patient management, still only 0.8-1.3% of acute ischaemic stroke (AIS) patients receive their intravenous thrombolysis (IVT) within the so-called golden hourthe first 60 min after symptom onset, when chances of full recovery are highest. 1,2 Many reports on stroke scales, [3][4][5][6][7] emergency medical service (EMS) training and educational programmes, [8][9][10][11][12] structured EMS pre-notification to hospital stroke teams, [13][14][15] emergency department streamlining [16][17][18][19][20] and different triage pathways (mothership vs drive the doctor vs drip and ship) [21][22][23][24][25][26][27][28][29][30][31] have all demonstrated an improvement of treatment numbers and times, but timely delivery of the available and highly beneficial reperfusion therapies [IVT and mechanical thrombectomy (MT)] to AIS patients is still underachieved. Furthermore, delays in onset to treatment times correlate to longer bolus to reperfusion times in AIS patients with proximal intracranial occlusions treated with IVT.…”

Feasibility of Catalpol Intranasal Administration and Its Protective Effect on Acute Cerebral Ischemia in Rats via Anti-Oxidative and Anti-Apoptotic Mechanisms

“… 2 Early use of drug in acute phase is the key to the treatment of ischemic stroke. 3 Cerebral ischemia patients in a short period of time are very likely to appear on one side hemiplegia, aphasia, more serious coma or death. 4 …”

“…2 Early use of drug in acute phase is the key to the treatment of ischemic stroke. 3 Cerebral ischemia patients in a short period of time are very likely to appear on one side hemiplegia, aphasia, more serious coma or death. 4 Because the onset of cerebral ischemia is urgent, the attack is not predictable, and the disability rate and mortality rate are high, rapid control is the key to treatment.…”

Content Analysis of Stroke Teleconsultation Recordings in the Moravian-Silesian Region, Czech Republic

“…Prenotification by EMS has been associated with decreased prehospital (4)(5)(6) as well as in-hospital times (4,5,(7)(8)(9)(10) and increased thrombolytic administration rates (5,9,10). Prenotification by EMS can further facilitate early activation of stroke interventional teams.…”