德国慕尼黑路德维希-马克西米利安大学学术教学医院Gordian J. Hubert团队，分析了德国非城市地区急性缺血性卒中患者使用飞行干预团队或患者院间转移与血管内血栓切除时间的相关性。这一研究成果于2022年5月5日发表在《美国医学会杂志》上。

血管内血栓切除术（EVT）治疗急性缺血性中风的益处具有高度的时间依赖性，对于偏远地区的患者来说，加快治疗是一个挑战。

为了确定与患者院间转移相比，飞行干预团队的部署是否与急性缺血性卒中患者血管内血栓切除术时间缩短和临床疗效改善相关，研究组进行了一项非随机对照干预研究，在交替的几周内比较了两种护理系统。这项研究在德国的一个非城市地区进行，包括远程中风网络中的13个初级远程医疗辅助中风中心。

2018年2月1日至2019年10月24日，共有157名急性缺血性中风患者被纳入研究，他们决定进行血栓切除术，并开始在一级中风中心部署EVT飞行干预团队或将EVT患者院间转移到转诊中心。最终随访日期为2020年1月31日。主要结局是从决定进行血栓切除术到开始手术的时间延迟（分钟）。次要结局包括3个月后的功能预后，由改良Rankin量表评分决定（残疾评分从0[无缺陷]到6[死亡]）。

157名患者的中位年龄为75岁，80名（51%）为女性，72名接受飞行团队治疗，85人接受转院治疗。飞行团队组有60名患者（83%）接受EVT，转院组有57名（67%）。飞行团队组从决定进行EVT到开始手术的中位时间为58分钟，转院组为148分钟，组间差异为90分钟，差异显著。飞行团队组59名患者3个月后的改良Rankin量表中位评分为3分，EVT组57名患者的中位评分亦为3分，残疾程度较轻的校正后共同优势比为1.91，组间无显著差异。

研究结果表明，在德国的一个非城市中风网络区中，将飞行干预团队部署到当地中风中心，与将患者转院到转诊中心相比，显著缩短了急性缺血性中风患者进行EVT的时间。该发现可能支持考虑为某些中风护理系统组建飞行干预团队，尽管仍需进一步研究来确认长期临床预后，并了解对其他地理环境的适用性。

附：英文原文

Title: Association Between Use of a Flying Intervention Team vs Patient Interhospital Transfer and Time to Endovascular Thrombectomy Among Patients With Acute Ischemic Stroke in Nonurban Germany

Author: Gordian J. Hubert, Nikolai D. Hubert, Christian Maegerlein, Frank Kraus, Hanni Wiestler, Peter Müller-Barna, Wolfgang Gerdsmeier-Petz, Christoph Degenhart, Katharina Hohenbichler, Dennis Dietrich, Thomas Witton-Davies, Angelika Regler, Laura Paternoster, Miriam Leitner, Florian Zeman, Michael Koller, Ralf A. Linker, Philip M. Bath, Heinrich J. Audebert, Roman L. Haberl

Issue&Volume: 2022-05-05

Abstract:

Importance  The benefit of endovascular thrombectomy (EVT) for acute ischemic stroke is highly time-dependent, and it is challenging to expedite treatment for patients in remote areas.

Objective  To determine whether deployment of a flying intervention team, compared with patient interhospital transfer, is associated with a shorter time to endovascular thrombectomy and improved clinical outcomes for patients with acute ischemic stroke.

Design, Setting, and Participants  This was a nonrandomized controlled intervention study comparing 2 systems of care in alternating weeks. The study was conducted in a nonurban region in Germany including 13 primary telemedicine-assisted stroke centers within a telestroke network. A total of 157 patients with acute ischemic stroke for whom decision to pursue thrombectomy had been made and deployment of flying intervention team or patient interhospital transfer was initiated were enrolled between February 1, 2018, and October 24, 2019. The date of final follow-up was January 31, 2020.

Exposures  Deployment of a flying intervention team for EVT in a primary stroke center vs patient interhospital transfer for EVT to a referral center.

Main Outcomes and Measures  The primary outcome was time delay from decision to pursue thrombectomy to start of the procedure in minutes. Secondary outcomes included functional outcome after 3 months, determined by the distribution of the modified Rankin Scale score (a disability score ranging from 0 [no deficit] to 6 [death]).

Results  Among the 157 patients included (median [IQR] age, 75 [66-80] y; 80 [51%] women), 72 received flying team care and 85 were transferred. EVT was performed in 60 patients (83%) in the flying team group vs 57 (67%) in the transfer group. Median (IQR) time from decision to pursue EVT to start of the procedure was 58 (51-71) minutes in the flying team group and 148 (124-177) minutes in the transfer group (difference, 90 minutes [95% CI, 75-103]; P<.001). There was no significant difference in modified Rankin Scale score after 3 months between patients in the flying team (n=59) and transfer (n=57) groups who received EVT (median [IQR] score, 3 [2-6] vs 3 [2-5]; adjusted common odds ratio for less disability, 1.91 [95% CI, 0.96-3.88]; P=.07).

Conclusions and Relevance  In a nonurban stroke network in Germany, deployment of a flying intervention team to local stroke centers, compared with patient interhospital transfer to referral centers, was significantly associated with shorter time to EVT for patients with acute ischemic stroke. The findings may support consideration of a flying intervention team for some stroke systems of care, although further research is needed to confirm long-term clinical outcomes and to understand applicability to other geographic settings.

DOI: 10.1001/jama.2022.5948

Source: https://jamanetwork.com/journals/jama/fullarticle/2791843