Stroke interhospital nursing transport to thrombectomy capable center

Objectives : Occlusion of a large arterial trunk responsible for ischemic stroke requires mechanical thrombectomy (MT) as early as possible [1-6] to improve the functional and vital prognosis of these patients. If a patient is admitted to a center without access to MT, an inter -hospital transfer to a referral center is usually carried out by a physician-led mobile emergency and resuscitation service. As the indications for MT expand, the availability of this medical presence is becoming increasingly critical. The aim of this study is to determine whether inter-hospital nursing transport can be validated for these patients requiring MT, and to define the predictive criteria for a potential major complication (MC) that would justify the presence of a physician during this transfer. Methods : This was a single-center prospective observational study, conducted from January 1, 2015 to December 31, 2018 (derivation cohort) and then from January 1 to December 31, 2019 (validation cohort), including all consecutive patients with ischemic stroke with occlusion of a large intracranial artery transferred for MT to the thrombectomy capable center (distance = 156 km). In both cohorts, complications occurring during transfer were recorded in a database. Results : In our derivation cohort (253 patients), 3 criteria were predictive of MC during interhospital transfer : basilar artery occlusion (p < 0.0001), initial National Institutes of Health Stroke scale (NIHSS) >22 (p < 0.005), and history of fibrillation (p < 0.04). Applying these criteria to our validation cohort (112 patients), no MC was recorded and 16 patients (14.3 %) had a minor complication. Conclusion : In view of mechanical thrombectomy, an inter-hospital nursing transport must be favored in the absence of occlusion of the basilar artery, when the initial NIHSS score is no higher than 22 and in the absence of a history of atrial fibrillation.