Stroke Management in Critical Care Transport Medicine: A Consensus Statement

Area of Science:

• Emergency Medicine
• Neurology
• Critical Care Transport Medicine

Background:

• Prehospital care for acute ischemic stroke (AIS) presents numerous challenges.
• Knowledge gaps lead to inconsistent practices in diagnosis, patient positioning, stroke mimic evaluation, destination selection, and hemodynamic management.
• Experts convened to discuss current and optimal prehospital AIS care.

Purpose of the Study:

• To identify challenges and knowledge gaps in prehospital acute ischemic stroke care.
• To discuss best practices and research priorities in critical care transport medicine (CCTM).
• To inform future standardized guidelines for prehospital AIS management.

Main Methods:

• A survey of international CCTM professionals at the Air Medical Physician Symposium Lite informed discussions.
• Survey results covered best practices, knowledge gaps, translation barriers, and research priorities.
• Audience voting ranked priority items following lectures and panel discussions.

Main Results:

• Significant challenges include inaccurate AIS identification tools, unclear destination protocols, and conflicting hemodynamic management guidelines.
• Effective prehospital blood pressure management is crucial.
• The impact of air medical transport on AIS patient outcomes is a top research priority.

Conclusions:

• There is a need for further research and standardized guidelines in CCTM.
• Improvements in diagnostic tools, destination protocols, and evidence-based hemodynamic management are essential.
• Enhanced prehospital care aims to improve outcomes for AIS patients during critical care transport.