Brain Emergency Management Initiative (BEMI-S): Assessment of Embolectomy Transfer Times Using a Novel Stroke System...

Recent studies of national stroke door-in-door-out (DIDO) times found that most transfers for acute interventions are not completed within the recommended time frame. There is a critical need for effective emergent transfer protocols to improve outcomes. The Brain Emergency Management Initiative (BEMI) is a stroke transfer protocol connecting patients with acute stroke at spoke sites to a hub center for embolectomy. BEMI has been shown to significantly reduce transfer time metrics through rapid transit activation, CT head/CTA bundling, digital image sharing, standardized documentation, and remote patient admission. In this study, we evaluated the sustainability of BEMI's impact on reduction of these transfer metrics.

We assessed data for patients transferred for embolectomy in our stroke system. Patients were compared across 3 groups: before the protocol ("pre-BEMI"), the initial year of protocol implementation ("BEMI"), and the contemporaneous 5 years of protocol usage ("BEMI-S") to assess for sustainability. Time metrics assessed include DIDO time, time from treatment decision to groin puncture (TDGP), and a safety outcome of symptomatic ICH (sICH) rate.

Four hundred twenty-nine transfers were evaluated, with a final sample size of 271 patients (pre-BEMI n = 31, BEMI n = 32, BEMI-S n = 208). A significantly shorter median DIDO time was found in the BEMI groups (pre-BEMI median = 143 minutes vs BEMI = 118 minutes, p = 0.015; vs BEMI-S = 97 minutes, p = 2.1e-07). DIDO time also improved significantly from BEMI to BEMI-S groups (118 vs 97 minutes; p = 0.0005). TDGP was significantly reduced in the BEMI and BEMI-S groups compared with the pre-BEMI group (pre-BEMI median = 155 minutes vs BEMI = 130 minutes, p = 0.01; vs BEMI-S = 125 minutes, p = 4.15e-13) but was similar between the BEMI and BEMI-S groups (130 vs 125 minutes, p = 0.89). Symptomatic ICH rates were similar before and immediately after BEMI implementation but significantly reduced in the BEMI-S group (pre-BEMI 12.9%, vs BEMI 15.6%, p = 1, vs BEMI-S 2.4%, p = 0.037; BEMI vs BEMI-S p = 0.014).

The BEMI protocol significantly improved transfer (DIDO) time by 46 minutes and treatment time (TDGP) by 25 minutes in our stroke network, showing continuous sustainability. sICH rates significantly lowered by over 10% with continued use of the BEMI protocol. Our protocol builds on similar rapid transfer stroke protocols through incorporating unique features such as air transit, video telestroke specialist evaluation, and rapid on-loading protocols with uniform documentation.