Helistroke: Neurointerventionalist helicopter transport for interventional stroke treatment: Proof of concept and rationale

Ferdinand Hui, Amgad El Mekabaty, Jacky Schultz, Kelvin Hong, Karen M Horton, Victor Urrutia, Imama Naqvi, Shawn Brast, John K. Lynch, Zurab Nadareishvili

Research output: Contribution to journalArticle

Abstract

Background and purpose It is increasingly recognized that time is one of the key determinants in acute stroke outcome when interventional stroke therapy is applied. With increasing device efficacy and understanding of imaging triage options, reducing pretreatment time loss may be a critical component of improving interventional stroke outcomes for the population at large. Time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure. Applying this same principle to interventional stroke management may be a valid paradigm. Methods Previous logistical deliberation with hospital and Medevac companies was carried out to provide the rationale and funding for helicopter transfer of a neurointerventionalist to an in-network hospital with an on-site angiographic suite. An appropriate patient with large vessel occlusion and an NIH Stroke Scale score 8 was identified. MRI was performed, then the Medevac transport system was activated and the intervention was carried out. Times were collected during the case and assessed for time efficiency. Results The proof of concept case was identified and Medevac was consulted at 12:13 after verifying that no in-house emergencies would prevent physician departure. Weather clearance was obtained and stroke intervention confirmed as a go at 12:24. Groin puncture occurred at 13:07 and the intervention was completed at 13:41. The total time from decision-to-treat to groin puncture was 43 min and groin closure was completed at 77 min from decision-to-treat. Conclusions This proof of concept case is presented for logistical, financial and use-case analysis. As it is a first case, times can likely be improved. We assert that this model may be another option in the spoke-and-hub design of stroke systems of care.

Original languageEnglish (US)
Pages (from-to)225-228
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume10
Issue number3
DOIs
StatePublished - Mar 1 2018

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Aircraft
Stroke
Sorbitol
Groin
Therapeutics
Punctures
Physicians
Triage
Weather
Emergencies
Equipment and Supplies

Keywords

  • Angiography
  • Economics
  • Intervention
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Helistroke : Neurointerventionalist helicopter transport for interventional stroke treatment: Proof of concept and rationale. / Hui, Ferdinand; El Mekabaty, Amgad; Schultz, Jacky; Hong, Kelvin; Horton, Karen M; Urrutia, Victor; Naqvi, Imama; Brast, Shawn; Lynch, John K.; Nadareishvili, Zurab.

In: Journal of NeuroInterventional Surgery, Vol. 10, No. 3, 01.03.2018, p. 225-228.

Research output: Contribution to journalArticle

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abstract = "Background and purpose It is increasingly recognized that time is one of the key determinants in acute stroke outcome when interventional stroke therapy is applied. With increasing device efficacy and understanding of imaging triage options, reducing pretreatment time loss may be a critical component of improving interventional stroke outcomes for the population at large. Time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure. Applying this same principle to interventional stroke management may be a valid paradigm. Methods Previous logistical deliberation with hospital and Medevac companies was carried out to provide the rationale and funding for helicopter transfer of a neurointerventionalist to an in-network hospital with an on-site angiographic suite. An appropriate patient with large vessel occlusion and an NIH Stroke Scale score 8 was identified. MRI was performed, then the Medevac transport system was activated and the intervention was carried out. Times were collected during the case and assessed for time efficiency. Results The proof of concept case was identified and Medevac was consulted at 12:13 after verifying that no in-house emergencies would prevent physician departure. Weather clearance was obtained and stroke intervention confirmed as a go at 12:24. Groin puncture occurred at 13:07 and the intervention was completed at 13:41. The total time from decision-to-treat to groin puncture was 43 min and groin closure was completed at 77 min from decision-to-treat. Conclusions This proof of concept case is presented for logistical, financial and use-case analysis. As it is a first case, times can likely be improved. We assert that this model may be another option in the spoke-and-hub design of stroke systems of care.",
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