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

Carla N Wood1, Dawn M Meyer2, Ben Shifflett2

  • 1Department of Neurology, University of California Davis, Sacramento.

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Summary

The Brain Emergency Management Initiative (BEMI) protocol significantly reduced stroke transfer times and improved patient outcomes. This study demonstrates the protocol

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Healthcare Systems

Background:

  • National stroke door-in-door-out (DIDO) times indicate most acute intervention transfers exceed recommended timeframes.
  • Effective emergent transfer protocols are crucial for improving stroke patient outcomes.
  • The Brain Emergency Management Initiative (BEMI) is a stroke transfer protocol designed to connect spoke sites with a hub center for embolectomy.

Purpose of the Study:

  • To evaluate the sustainability of the Brain Emergency Management Initiative (BEMI) protocol's impact on reducing stroke transfer time metrics.
  • To assess the long-term effectiveness of BEMI in improving patient outcomes and safety.

Main Methods:

  • A retrospective analysis of 271 patients transferred for embolectomy within a stroke system.
  • Comparison of three groups: pre-BEMI, initial BEMI implementation year, and subsequent 5 years of BEMI usage (BEMI-S).
  • Assessment of key time metrics: DIDO time, time from treatment decision to groin puncture (TDGP), and symptomatic intracranial hemorrhage (sICH) rate.

Main Results:

  • Median DIDO time significantly decreased from 143 minutes (pre-BEMI) to 97 minutes (BEMI-S).
  • Median TDGP was significantly reduced from 155 minutes (pre-BEMI) to 125 minutes (BEMI-S).
  • Symptomatic ICH rates significantly decreased from 12.9% (pre-BEMI) to 2.4% (BEMI-S).

Conclusions:

  • The BEMI protocol demonstrates sustained effectiveness in significantly reducing stroke transfer and treatment times.
  • Continued implementation of the BEMI protocol leads to a significant reduction in symptomatic intracranial hemorrhage rates.
  • BEMI's unique features, including air transit and telestroke evaluation, contribute to its success in optimizing emergent stroke care.