Initial experience suggests strategy is faster, feasible, cost-effective
When a patient needing endovascular treatment presented at one such primary stroke center with onsite angiographic facilities in Maryland, a logistical plan it had worked out with an in-network comprehensive stroke center 39.4 miles away was activated.
Nine minutes after completing MRI and MR angiography and 59 minutes after stroke onset, the hub hospital's neurointerventionalist was called. It then took 25 minutes to consult the Medevac service, get weather clearance, and confirm that there were no other emergencies to attend to before the hospital had the doctor on the helipad for the 19-minute helicopter ride to the patient's location.
Total time from decision-to-treat to groin puncture was 43 min; groin closure was achieved by minute 77, reported researchers led by Ferdinand K. Hui, MD, of Johns Hopkins Hospital in Baltimore, in the Journal of Neurointerventional Surgery.
"These times are competitive with single institution times to treatment without transfer, which should be maximally expeditious," they suggested.
Symptom onset-to-groin puncture time was 119 minutes; time elapsed from symptom onset to groin closure was 153 minutes.
The patient had a large vessel occlusion and an NIH Stroke Scale score greater than 8.
Arguing that this approach could be practical -- and not too costly -- in the real world, Hui and colleagues wrote that helicopter transfer of the neurointerventionalist cost one-fifth of similar transport for a patient.
"The direct cost differential between transporting a physician versus a patient will vary between regions and hospital networks. However, transporting a physician would most probably offer a many-fold reduction in transport cost compared to transporting a stroke patient, as the cost of nursing care, monitoring equipment and other staffing would be eliminated. Flying a physician is also less time intensive as the hand-off protocols and line checks necessary for moving a patient are completely obviated."
"From the U.S. healthcare perspective, given the overall cost-effectiveness of endovascular therapy, the Helistroke approach will result in both immediate direct cost savings and also in indirect long-term cost-benefit associated with favorable stroke outcome," the authors suggested.