Prehospital Intravenous Access Is Associated with Decreased Door-to-CT and Door-to-Intravenous Thrombolysis Time, but not Door-to-Endovascular Therapy Time

Geoffrey Sowitz¹Courtney D. Wham²Daria Nicke²Ian Espinoza²Monisha Lensink-Vasan²Breanna Thrower²Jacob Dueñas²Stefan Sillau³Andra Farcas²Michelle Leppert³Elizabeth Molina Kuna⁴Layne Dylla^5*

• ¹University of Colorado Anschutz Medical Campus, Aurora, United States
• ²University of Colorado Anschutz Medical Campus Department of Emergency Medicine, Aurora, United States
• ³University of Colorado Anschutz Medical Campus Department of Neurology, Aurora, United States
• ⁴University of Colorado Cancer Center, Aurora, United States
• ⁵Yale School of Medicine Department of Emergency Medicine, New Haven, United States

Introduction: Prehospital stroke care can influence in-hospital stroke care, including facilitating earlier diagnosis and treatment. This study sought to determine the association between prehospital IV access and time to computed tomography (CT), intravenous thrombolytic administration, and endovascular therapy in patients with a stroke. Methods: This was a multi-institutional, multi-agency retrospective analysis of patients who were identified as having stroke-like presentations by EMS and had a final clinical diagnosis of stroke or transient ischemic attack from January 1, 2020, to December 31, 2022. Data were analyzed using descriptive statistics and multivariable linear regressions controlling for: receiving hospital stroke certification level, sex, age, initial NIHSS score, hospital prenotification of suspected stroke, and EMS-documented blood glucose level, stroke scale, and last known well. Results: Of the 3,109 patients in the study, 91.2 % (n = 2,834) arrived with IV access obtained by EMS. Patients who arrived with IV access had a median door-to-CT time of 10 minutes (interquartile range [IQR] 7–16 minutes) compared to those without IV access who had a median door-to-CT time of 12 minutes (IQR 8–21 minutes) (p < 0.05). After adjusting for covariates, arrival without IV access increased the door-to-CT time by 26 % (ratio estimate 1.26, 95 % CI 1.14–1.39) compared to those with IV access. Similarly, after controlling for covariates, lack of prehospital IV access was associated with increased time to intravenous thrombolysis (ratio estimate 1.17, 95 % CI 1.01–1.36), but not with time to endovascular thrombectomy (ratio estimate 1.05, 95 % CI 0.82–1.33) compared to those with prehospital IV access. Conclusions: EMS insertion of an IV prior to hospital arrival was associated with shorter time to imaging and shorter time to intravenous thrombolysis but was not associated with a difference in time to endovascular thrombectomy.