According to a single-patient, proof-of-concept study conducted by researchers from Johns Hopkins Medicine, emergency care involving a stroke specialist being transported by helicopter to provide critical care to a stroke patient is not only feasible, but also saves money and more importantly allows the patient to receive critical care quicker than transporting the patient by ambulance to the hospital first.
However, the study was not specifically designed to determine whether “helistroke service” would improve health outcomes for stroke patients, because this has been validated in previous studies. Stroke patient do best when treatment is rendered in 100 minutes or less, according to those previous studies.
The researchers believe that this is the first experiment to focus on transporting a stroke specialist by helicopter to the scene of a stroke victim and rendering a standard intervention for a stroke.
The traditional model of care involves a patient, who is experiencing a transient ischemic stroke or TIA (when a clot lodges in a blood vessel and cuts off the blood supply to the brain) is transported to a nearby hospital, with a specialized stroke center. At the hospital the physician will perform a catheter-direct thrombolysis. During the procedure, a long flexible tube, catheter, is inserted into the groin and threaded to the small arteries of the brain to the blood clot. Once the catheter is in place, the physician will then deliver drugs (thrombolytics) directly to the blood clot to break it up.
A recent study that analyzed the findings of an international, multicenter trial, revealed a 91 percent chance of positive health outcome, if patients’ blood flow to the brain was “restored within 150 minutes of stroke.” The researchers discovered that an extra 60 minutes of delay reduced the outcome by 10 percent. To achieve the best probability of a favorable stroke outcome, the pre-intervention time was determined to be less than 100 minutes.
The researchers flew the associate professor of radiology and radiological science at Johns Hopkins, Ferdinand K. Hui M.D., by Johns Hopkins Lifeline. To evaluate the practicability of the physician-to-patient model, Hui was transported to multiple hospitals in Baltimore and Washington, D.C. to initiate standard treatment for stroke to a patient. Hui has worked alongside medical experts at Suburban, which is an entity of the Johns Hopkins Health System, to prepare them to utilize catheter-based treatment.
If the patient was shown to have a score of 8 on the National Institutes of Health Stroke Scale (NIHSS) and a large vessel blockage, he/she was eligible to be treated as part of the pilot study. These findings are considered to be a severe stroke. The NIHSS was developed in 1989 and is a 15-item impairment scale that is utilized to measure the severity of a stroke.
A patient at the Suburban Hospital was identified at 11:12 a.m. in January 2017. At 11:46 a.m. scans to view the patient’s brain tissue and blood vessels was initiated and at 11:58 a.m., the scan was completed.
When Hui was alerted at 12:07 p.m., he was working in Johns Hopkins Hospital. The Johns Hopkins Lifeline was notified at 12:13 p.m. At 12:24 p.m., weather clearance for the helicopter to takeoff was obtained and it took 19 minutes for the helicopter to reach Suburban Hospital from Baltimore.
At 1:07 p.m. Hui performed the catheterization procedure, which was completed 1:41 p.m. The helistroke service could prove to be valuable for stroke patients, since it can potentially improve stroke patient health outcomes, decrease transport time and also extend optimal standards to areas where specialized care limited, including rural communities, Hui says.
Hui also warns that the helistroke service may be restricted by certain factors, poor weather conditions, transportation costs and specialist availability. However, the service could reduce length of stay in hospital and rehabilitation for all stroke patients, while also potentially eliminating costs of nursing care, ambulance service and monitoring equipment.
The study was published in the Journal of Neurointerventional Surgery on May 3, 2017.