HEMS for Mechanical Thrombectomy

Study Overview
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Brief Summary
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Elapsed time from the onset of stroke symptoms to the point of revascularization is the key determinant of the optimal outcome of acute ischemic stroke. Pharmacological treatment is less effective if the thrombus occluding the artery is big enough and mechanical thrombectomy is required to gain recanalization. Mechanical thrombectomy can be done only in comprehensive stroke centres. There are 5 comprehensive stroke centres in Finland which causes regional inequality when it comes to reaching mechanical thrombectomy in a reasonable time limit. The aims of the study is to measure the effect of dispatching a helicopter emergency medical services unit on the treatment delays of a stroke patient with large vessel occlusion. The HEMS unit is dispatched to both: getting patient directly to the comprehensive stroke centre as well as to interfacility tranfers.

Official Title
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Decreasing Prehospital Delay to Mechanical Thrombectomy Using a Helicopter Emergency Medical Services Unit

Conditions
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Ischemic Stroke

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - all adult patients transferred for mechanical thrombectomy from the South Ostrobothnia Hospital District to the Tampere University Hospital Exclusion Criteria: The neurologist on call at the Tampere University hospital deems the patient unable to benefit from mechanical thrombectomy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Helicopter Emergency Medical Services (HEMS)<br>Patients transported to the comprehensive stroke centre at least in some part by a HEMS unit | |
| Ground Emergency Medical Services (GEMS)<br>Patients transported to the comprehensive stroke centre solely by an ambulance | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The difference of transport times from the onset of ambulance transport to Tampere university hospital until the recording of CT Scout image | minutes | from onset of symptoms up to 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The difference of onset to revascularisation time between the groups from the onset of symptoms (last known well) until save time of post revascularization image | minutes | from onset of symptoms up to 24 hours | 
| The time difference from the onset of symptoms (last known well) until the save time of post revascularization image | minutes | from onset of symptoms up to 24 hours | 
| 90 days modified Rankin scale outcome | mRS 0-6 | telephone interview 90 days after mechanical thrombectomy | 
| Availability of the ambulance to the next emergency medical services mission in its own region. Time to next ems mission | hours | from the beginning of ambulance transport up to 24 hours |