A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
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DOI：
10.1371/journal.pone.0264539
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Alexander A
中科院分区：
文献类型：
--
作者：
Glober N;Supples M;Persaud S;Kim D;Liao M;Glidden M;O'Donnell D;Tainter C;Boustani M;Alexander A
在许多系统中，患有大血管闭塞（LVO）卒中的患者在转运到具有血栓切除术能力的中心时会出现延迟。该试点研究检查了使用新的紧急医疗服务（EMS）协议，以加快与LVO患者转移到综合卒中中心（CSC）。从2020年10月1日到2021年2月22日，印第安纳波利斯EMS试行了一项协议，其中护理人员在运送可能中风的患者后，留在患者的床边，直到急诊科或神经科医生释放。在可能存在LVO的患者中，EMS提供者留在床边，直到完成临床评估和CT血管造影（CTA）。如果有需要，床边的护理人员会通过同一辆救护车将患者转移到附近一家能够进行血栓切除术的CSC，并与该CSC签订了自动转移协议。这项为期5个月的混合方法研究包括对方案使用、转运次数、转运期间的安全性以及与通过传统机构间转运机构进行紧急转运相比转运节省的时间进行病例对照评估。在定性分析EMS供应商，和艾德医生和神经学家在发送和接收机构，完成了电子邮件调查的过程中，并提供了改进过程的建议。回答编码与归纳内容分析方法。在研究期间，该方案使用了42次;发现4例患者有LVO，并转移到CSC。未发生不良事件。从决定转移到到达CSC的中位时间为27.5分钟（IQR 24.5-29.0），而同期急性非卒中转移的中位时间为314.5分钟（IQR 204.0-459.3）。提供者印象的主要主题包括：对方案的不完全了解、顺利的过程、EMS离开医院后激活卒中警报时的挑战、EMS更多地参与患者护理以及对沟通和效率的评论。该初步研究证明了一种加速LVO患者血管内治疗的新方法的可行性、安全性和有效性。
In many systems, patients with large vessel occlusion (LVO) strokes experience delays in transport to thrombectomy-capable centers. This pilot study examined use of a novel emergency medical services (EMS) protocol to expedite transfer of patients with LVOs to a comprehensive stroke center (CSC). From October 1, 2020 to February 22, 2021, Indianapolis EMS piloted a protocol, in which paramedics, after transporting a patient with a possible stroke remained at the patient’s bedside until released by the emergency department or neurology physician. In patients with possible LVO, EMS providers remained at the bedside until the clinical assessment and CT angiography (CTA) were complete. If indicated, the paramedics at bedside transferred the patient, via the same ambulance, to a nearby thrombectomy-capable CSC with which an automatic transfer agreement had been arranged. This five-month mixed methods study included case-control assessment of use of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergent transfers via conventional interfacility transfer agencies. In qualitative analysis EMS providers, and ED physicians and neurologists at both sending and receiving institutions, completed e-mail surveys on the process, and offered suggestions for process improvement. Responses were coded with an inductive content analysis approach. The protocol was used 42 times during the study period; four patients were found to have LVOs and were transferred to the CSC. There were no adverse events. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes (IQR 24.5–29.0), compared to 314.5 minutes (IQR 204.0–459.3) for acute non-stroke transfers during the same period. Major themes of provider impressions included: incomplete awareness of the protocol, smooth process, challenges when a stroke alert was activated after EMS left the hospital, greater involvement of EMS in patient care, and comments on communication and efficiency. This pilot study demonstrated the feasibility, safety, and efficiency of a novel approach to expedite endovascular therapy for patients with LVOs.
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