Background and Purpose:
Efficacy of mechanical thrombectomy for acute cerebral large vessel occlusion depends on time from symptom onset to reperfusion. While time to treatment in hospital has been optimized in these days, it is not well-known about improving time in pre-hospital when suspected stroke. We sought to analyze time from emergency medical services (EMS) dispatch to arterial puncture in stroke patients eligible for mechanical thrombectomy.
Methods:
We analyzed time components from EMS dispatch to puncture in patients with acute large vessel occlusion within 6 hours from onset treated with mechanical thrombectomy between April 2015 and December 2018. We assessed the associated factors with each time component and patient outcomes.
Results:
Consecutive 195 patients were included in this analysis. The median EMS dispatch-to-scene, on-scene, transport, door-to-puncture (DTP), and scene-to-puncture (STP) times were 4, 16, 12, 40, and 70 minutes, respectively. Percentage of favorable outcomes were significantly higher in patients with STP within 60 minutes (57.5% vs 35.8%, p<0.05). Direct call from EMS, lower number of acceptance request times, shorter transport distance, and out-of-home onset were significantly associated with STP within 60 minutes (P<0.01). EMS education program shortened STP times and increased use of direct call which significantly reduced on-scene (15.9 vs 20.2), DTP (40.4 vs 57.8), and STP (68.9 vs 91.5) times (P<0.001).
Conclusions:
Reducing time in pre-hospital and in-hospital interact with each other. Education program and use of direct call from EMS contributed to reducing these times.
The Improvement Plan of Organization Management Through the Survey of Actual Condition in Construction Work
