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Drip-and-ship toward mothership model for mechanical thrombectomy during COVID-19 pandemic: a retrospective analysis.
Paolucci, Matteo; Biguzzi, Sara; Cordici, Francesco; Romoli, Michele; Altini, Mattia; Agnoletti, Vanni; Fabbri, Andrea; Francesconi, Raffaella; Menarini, Maurizio; Perin, Tiziana; Ruggiero, Maria; Longoni, Marco.
  • Paolucci M; Neurology Unit, "M. Bufalini" Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, Cesena, 47521, FC, Italy. matteo.paolucci@auslromagna.it.
  • Biguzzi S; Headache and Neurosonology Unit, Campus Bio-Medico University, Rome, Italy. matteo.paolucci@auslromagna.it.
  • Cordici F; Neurology Unit, "M. Bufalini" Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, Cesena, 47521, FC, Italy.
  • Romoli M; Neurology Unit, "M. Bufalini" Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, Cesena, 47521, FC, Italy.
  • Altini M; Neurology Unit, "M. Bufalini" Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, Cesena, 47521, FC, Italy.
  • Agnoletti V; Medical Direction, AUSL Romagna, Ravenna, Italy.
  • Fabbri A; Intensive Care Unit, "M. Bufalini" Hospital, AUSL Romagna, Cesena, FC, Italy.
  • Francesconi R; Emergency Department, "Morgagni-Pierantoni" Hospital, AUSL Romagna, Forlì, FC, Italy.
  • Menarini M; Emergency Department, "M. Bufalini" Hospital, AUSL Romagna, Cesena, FC, Italy.
  • Perin T; Centrale Operativa 118 Romagna E Emergenza Territoriale Della Provincia Di Ravenna, AUSL Romagna, Ravenna, Italy.
  • Ruggiero M; Emergency Department, "Infermi" Hospital, AUSL Romagna, Rimini, RN, Italy.
  • Longoni M; Neuroradiology Unit, "M. Bufalini" Hospital, AUSL Romagna, Cesena, FC, Italy.
Neurol Sci ; 2022 Jan 31.
Article in English | MEDLINE | ID: covidwho-2244052
ABSTRACT

INTRODUCTION:

During the first wave of the COVID-19 pandemic in spring 2020, our stroke network shifted from a drip-and-ship strategy (transport of acute ischemic stroke patients to the nearest primary stroke centers) toward a mothership model (direct transportation to the Comprehensive Stroke Center). We retrospectively analyzed stroke network performances comparing the two models. PATIENTS AND

METHODS:

All spoke-district patients treated with endovascular thrombectomy (EVT) between 15th March-15th June 2019 (drip-and-ship) and 2020 (mothership) were considered. We compared onset-to-groin time (OGT) and onset-to-needle time (ONT) between the two periods. Secondarily, we investigated other performances parameters (percentage of IV thrombolysis, timing of diagnostic and treatment) and clinical outcome (3-month modified Rankin Scale).

RESULTS:

Twenty-four spoke-district patients in 2019 (drip-and-ship) and 26 in 2020 (mothership) underwent EVT. The groups did not differ for age, sex, risk factors, pre-stroke mRS 0-1, NIHSS, and ASPECTS distribution. The MS model showed a significant decrease of the OGT (162.5 min vs 269 min, p = 0.001) without significantly affecting the ONT (140.5 min vs 136 min, p = 0.853), ensuring a higher number of IV thrombolysis in combination with EVT (p = 0.030). The mothership model showed longer call-to-door time (median + 23 min, p < 0.005), but shorter door-to-needle (median - 31 min, p = 0.001), and door-to-groin time (- 82.5 min, p < 0.001). We found no effects of the stroke network model on the 3-month mRS (ordinal shift analysis, p = 0.753).

CONCLUSIONS:

The shift to the mothership model during the COVID-19 pandemic guaranteed quicker EVT without significantly delaying IVT.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal subject: Neurology Year: 2022 Document Type: Article Affiliation country: S10072-022-05903-5

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal subject: Neurology Year: 2022 Document Type: Article Affiliation country: S10072-022-05903-5