This 4-year population study (2019–2022) examined 226 adults with confirmed or suspected acute ischemic stroke transported by helicopter EMS (STARS) to a comprehensive stroke center in Alberta, Canada, to determine what proportion received neuro-intervention (endovascular thrombectomy or neurosurgery) and which pre-transport factors predicted it.
35% (n=80/226) received neuro-intervention; early (<6 h) and late (≥6 h) presenters had similar rates (36% vs. 31%, p=0.64). Pre-transport imaging (OR 5.3; 95% CI 1.8–10.7) and thrombolysis (OR 2.8; 95% CI 1.1–12.9) were the strongest independent predictors. A LAMS of 4–5 was associated with 92% neuro-intervention rate vs. 63% for lower scores. 23% (n=52) were 'low-yield' transports (died/palliated or discharged within 24 h without intervention).
- Single comprehensive stroke center in one Canadian province limits generalizability. - Exploratory multivariable regression; study was not powered for definitive predictor identification. - 'Low-yield' transport classification does not fully account for patients who benefited from timely transfer even without neuro-intervention.
Ensure pre-transport CT imaging and thrombolysis are completed at primary stroke centers before helicopter EMS transfer—these steps more than double to quintuple the odds of a patient receiving neuro-intervention. A LAMS of 4–5 can help identify the highest-yield candidates for urgent helicopter transport.
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