Abstract 59: Immediate Transport of Drip and Ship Cases is Safe
Background: Acute stroke treatment with intravenous (IV) tissue plasminogen activator (tPA) will increase if regions are organized and smaller hospitals can adopt the drip and ship model to administer IV tPA in consultation with a comprehensive stroke center prior to transfer. The Saint Luke’s Stroke Team has been working in that model for several years. We sought to determine if immediate transport with the IV tPA still running was safe, given that transport protocols are not standardized for BP control and neurological checks.
Methods: We retrospectively reviewed consecutive drip and ship cases from 2008 through 2010 and analyzed the incidence of symptomatic intracerebral hemorrhage (SICH) and BP >180/105 on arrival, inaccurate stroke diagnosis, need for intra-arterial (IA) treatment, mortality rate, and clinical outcomes as well as the location and size of the referring facilities.
Results: There were 1626 ischemic strokes over the 3 years, 717 (44%) of which were transferred. 145 (20%) of the transferred cases had IVtPA started at the referring hospital and then were immediately transported (drip and ship). Of the 63 referring hospitals, 29 were critical access hospitals of 25 beds or less. 90% were greater than 10 miles away, 63% were greater than 50 miles, and 25% were greater than 100 miles away. Mean age was 67.5 years. Mean admission NIHSS score was 10.4 (median 7 SD 9.3). Mean discharge NIHSS score was 3 (median 1 SD 6.9). There were 4 (2.7%) SICH on arrival. Two resulted in mortality and one of those had elevated BP on arrival (183/77). Fourteen cases (9.6%) had BP>180/105 on arrival. One of these was associated with SICH in transport and died (as noted).One other (admit BP 232/84) died without hemorrhage.10/14 had excellent clinical outcomes. Thirty-five (24%) went on to IA treatment. Mortality rate was 13.7% (20/145) and mRS 0-2 at 90 days was achieved in 72/114 (63%). mRS data was not available for the 2008 cases. Six cases (4.1%) were inaccurately diagnosed at the sending facility.
Conclusions: Immediate transport of patients with IVtPA infusing is safe with a very low incidence of SICH en route. Over 90% of cases had BP <180/105 on arrival. The good clinical outcomes observed in 63% of cases (mRS0-2 at 90 days) relate, in part, to early treatment in referring hospitals. Hospitals of every size can effectively and safely treat stroke victims with IVtPA if they have access to consultation and transfer agreements with experienced stroke centers.
- © 2012 by American Heart Association, Inc.