“Drip-and drive” may be superior to “drip-and-ship”

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Transferring interventional neuroradiologists (INR) to primary stroke centres to perform mechanical thrombectomy (“drip-and drive”) is feasible and could result in a significant reduction in time to puncture when compared to the “drip-and-ship”(moving patients to comprehensive stroke centres) approach.

The study, published in the Journal of NeuroInterventional Surgery, evaluated the time intervals of acute stroke management in two stroke care models, including one based on transportation of the interventionalist from a comprehensive stroke centre to treat patients in two primary stroke centres. The group—from the University Hospital Hamburg-Eppendorf, Hamburg, Elbe-Klinikum Stade, Stade, and Klinikum Lüneburg, Lüneburg, all in Germany—hypothesised that time intervals were not inferior for the “drip-and-drive” concept compared with the traditional “drip-and-ship” concept.

Patients treated with mechanical thrombectomy at the primary stroke centres (“drip-and-drive) were compared with patients transferred from primary stroke centres to comprehensive stroke centres for mechanical thrombectomy (“drip and-ship”) with regard to time delays. The time intervals assessed were: symptom onset to initial computerised tomography scan (CT), to angiography, and to recanalisation; the time from initial CT to phone call activation, to arrival, and to angiography; and the time from phone call activation to arrival and from arrival to angiography were also assessed.

Time delays with the “drip-and-ship” concept have been previously reported. These can be due to patient transportation, poor interfacility communication, and re-evaluation, with the organisation of patient transport often being among the most time consuming factor, as different services have to be coordinated and helicopter service availability (which is sometimes required) can be dependent on weather conditions.

In rural areas, ambulances can be constrained to certain areas, meaning different forms of transportation must be ordered. The handover of patients at the primary care centre to the transport service can be time consuming, often taking up to 20 minutes and, once the patient arrives at the comprehensive stroke care centre, they have to be revaluated clinically and by CT again. In this paper the time taken for this exceeded one hour on most occasions.

All of these factors delay the time to treatment. Forty-two patients were treated at primary stroke centres after transfer of an interventionalist, and 32 patients were transferred to comprehensive stroke centres for mechanical thrombectomy. There was no difference in the average time from onset to CT, and the time from CT to phone call between the groups. There were significant differences between the groups for the CT to arrival time (primary outcome measure; “D+D group”: median 121 [IQR 108–134] min vs 181 [157– 219] min for the “D+S group”; P<0.001).

Time difference between the groups increased to more than two hours for median CT to angiography times (median 123 [IQR 93–147] min vs 252 [228–275] min; P<0.001).

The group concluded that “drip-and-drive” was non-inferior to “drip-and-ship” and that in certain conditions “drip-and-drive” might be superior to “drip-and-ship”.

This research backs up the findings of a study that NeuroNews previously reported on from Mount Sinai Hospital in New York, USA.

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