Prehospital thrombolytic treatment of acute ischemic stroke using a remotely controlled CT scanner

Abstract

Abstract Timely access to diagnosis and treatment is crucial for improving stroke patients´ outcomes, but long prehospital transport times hinder timely treatment in rural areas. This study investigates the feasibility of using a remotely controlled computer tomography (CT) scanner at a decentralized medical center (DMC) to expedite prehospital intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). The study involved three phases: technical implementation and testing, procedure development, and clinical training. We used a Siemens Healthineers Syngo Virtual Cockpit system to remotely control the CT scanner at the DMC. This enabled use of the scanner without a radiographer on call at the DMC. Eligibility criteria for undergoing prehospital IVT at the DMC were established. Paramedics, nurses, and physicians underwent comprehensive training on stroke assessment, CT scanner operation, and communication protocols. Technical testing demonstrated excellent feasibility of the system. Simulation exercises showed efficient teamwork, achievement of door-to-needle times (DNT) below 20 min, and NIHSS score consistency in 95% of cases. Risk assessment identified potential challenges, with mitigation strategies implemented. This study demonstrates the feasibility of leveraging existing infrastructure to remotely control a CT scanner at a DMC, for prehospital IVT in a rural setting. This approach is promising for improving timely stroke diagnosis and treatment in rural areas.