Attending Jefferson Health NJ Cherry Hill, New Jersey, United States
Objectives: A mechanical thrombectomy (MT) is an invasive treatment that is not accessible to approximately 20% of stroke patients, especially in rural areas. Patients are often transferred to a tertiary hospital with a comprehensive stroke center (CSC) that has equipment necessary for MT. The distance between the local ED and tertiary hospital with a CSC is called “inter-hospital-distance” and is a critical time-period. The impact of helicopter EMS (HEMS) on hospital arrival time and patient outcomes in comparison to ground transport will be addressed. The goal of this study is to determine the outcomes of patients suffering stroke due to large-vessel-occlusion depending on whether they receive helicopter versus ground transport to a CSC.
Design: A structured review of current literature was utilized to understand the implications of HEMS on outcomes of patients suffering stroke due to large-vessel-occlusion. This review includes peer-reviewed research papers with a focus on acute ischemic strokes and inter-hospital distance. The change in time of inter-hospital travel and stroke outcomes is measured, dependent on whether the mode of transportation between hospitals is via helicopter or ambulance.
Results: HEMS transport patients had the highest rate of thrombolysis (29%) versus ground transfer (15%). The 90-day mortality was lower for HEMS (13%) patients versus ground transportation (18%). As inter-hospital distance increases, the time-to-thrombectomy increases less rapidly via HEMS transport versus ground transport. A delay of inter-hospital transfer is associated with worse outcomes. Less time-to-thrombectomy was achieved with HEMS with inter-hospital distances greater than 10 miles.
Conclusions: This study can help clinicians decide which transport a patient requires during inter-hospital travel to a CSC. Inter-hospital distances over 10 miles should strongly consider HEMS, especially in rural areas where CSCs are sparse. Patients with large-vessel-occlusion will have better outcomes with a MT, and a large barrier to achieve this treatment is inter-hospital travel to a CSC.
