For a study, researchers sought to determine if deploying a flying intervention team, as opposed to patient interhospital transfer, results in a faster time to endovascular thrombectomy and better clinical outcomes for patients with acute ischemic stroke. Nonrandomized controlled intervention research compared two care systems in alternate weeks. The study was conducted in a non-urban region, with 13 primary telemedicine-assisted stroke facilities participating in a telestroke network. Between February 1, 2018, and October 24, 2019, 157 patients with acute ischemic stroke were registered, with the decision to pursue thrombectomy made, and the deployment of a flying intervention team or patient interhospital transfer began. The last follow-up was scheduled for January 31, 2020. The key result was a time delay of minutes between the decision to undertake thrombectomy and the start of the procedure. The distribution of the modified Rankin Scale score was used to determine the functional outcome after 3 months (a disability score ranging from 0 [no deficit] to 6 [death]).
Among the 157 patients (median [IQR] age, 75 [66-80] years; 80 [51%] women), 72 were treated by a flying team and 85 were transferred. EVT was accomplished on 60 patients (83%) in the flying team group and 57 patients (67%) in the transfer group. The median (IQR) time from decision to seek EVT to procedure commencement in the flying team group was 58 (51-71) minutes and 148 (124-177) minutes in the transfer group (difference, 90 minutes [95% CI, 75-103]; P<.001). After 3 months, there was no statistically significant difference in modified Rankin Scale score between patients in the flying team (n = 59) and transfer (n = 57) groups who received EVT (median [IQR] score, 3 [2-6] vs 3 [2-5]; adjusted common odds ratio for less disability, 1.91 [95% CI, 0.96-3.88]; P=.07).
In a nonurban stroke network, deployment of a flying intervention team to local stroke facilities was substantially linked with shorter time to EVT for patients with acute ischemic stroke as compared to patient interhospital transfer to referral hospitals. Although more study was needed to establish long-term clinical results and clarify relevance to different geographic situations, the findings may encourage the adoption of a flying intervention team for specific stroke systems of care.
Reference:jamanetwork.com/journals/jama/article-abstract/2791843
