Abstract Details

Title Telemedicine-Enabled Ambulances for Prehospital Acute Stroke Management: A Pilot Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-007

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

Authors/Disclosures
Ehab Y. Harahsheh, MBBS PRESENTER	Dr. Harahsheh has nothing to disclose.
Stephen W. English, MD (Mayo Clinic)	Dr. English has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Brainomix.
Bart Demaerschalk, MD, MSc, FRCPC, FAAN (Mayo Clinic)	Dr. Demaerschalk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Demaerschalk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Demaerschalk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurologist . The institution of Dr. Demaerschalk has received research support from NICHD.
Kevin M. Barrett, MD, FAAN (Mayo Clinic)	Dr. Barrett has nothing to disclose.
William D. Freeman, MD, FAAN (Mayo Clinic)	Dr. Freeman has nothing to disclose.

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