Telemedicine-Enabled Ambulances for Prehospital Acute Stroke Management: A Pilot Study
Ehab Harahsheh1, Stephen English2, Bart Demaerschalk1, Kevin Barrett2, David Freeman2
1Neurology, Mayo Clinic Arizona, 2Neurology, Mayo Clinic Florida
Objective:
To assess the feasibility and potential scalability of telemedicine-enabled ambulances for the prehospital evaluation of patients with suspected acute stroke symptoms.
Background:
Mobile stroke units have been shown to help improve outcomes of acute stroke patients in the prehospital setting but several logistical challenges have been prevented its widespread use. More recently, the concept telemedicine-enabled ambulances have gained some popularity, but the current literature pertaining to its use for stroke patients in the prehospital setting is scarce and limited.
Design/Methods:
A pilot study of telemedicine-enabled ambulances for evaluating patients with suspected acute stroke symptoms en-route at two tertiary academic comprehensive stroke centers from January 1, 2018 to February 5, 2024. Charts of included patients were reviewed for demographic data, vascular risk factors, final diagnosis, time from arrival to neuroimaging, door to needle (DTN) and door to puncture (DTP) times in patients eligible for acute treatment, and any reported technical challenges during audio-video consultations
Results:
Forty-seven patients (mean age 68.0 years; 62% males) were evaluated via telemedicine-enabled ambulances, of which 35 (74%) where for hospital-to-hospital transferred patients. Mean time from arrival to neuroimaging was 11.8 minutes. Twenty-nine patients (62%) were diagnosed with acute ischemic stroke and the remainder were diagnosed with intracranial hemorrhage (n=13), seizure (n=2), brain mass (n=1) or other diagnoses (n=3). Four patients (9%) received intravenous thrombolysis with alteplase (mean DTN 30.3 minutes), and 15 patients (32%) underwent mechanical thrombectomy (mean DTP time 72 minutes). Technical challenges were reported in 15/42 (36%) cases, of which 10 (67%) were related to poor internet connectivity.
Conclusions:
Telemedicine-enabled ambulances are novel, feasible and potentially scalable options for evaluating patients with suspected acute stroke in the prehospital setting. However, optimization of infrastructure, staffing models, and internet connectivity is necessary, and larger studies evaluating the clinical and cost effectiveness of this approach are needed before widespread implementation
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