Safety of air medical transportation after tissue plasminogen activator administration in acute ischemic stroke

Background and Purpose-We sought to determine the safety of air medical tra nsport (AMT) of patients with acute ischemic stroke (AIS) immediately after or during administration of tissue plasminogen activator (tPA). Patients w ith AIS treated with tPA in nonuniversity hospitals frequently need transfe r to tertiary care centers that can provide specialized care. AMT is a wide ly available mode of transport that is crucial in providing expedient and q uality health care to critically ill patients while assuring high level of care during transportation. The safety of AMT of patients with AIS after or during administration of tPA has not been examined. Methods-We performed retrospective chart review of 24 patients with AIS who were treated with intravenous tPA and transferred by helicopter to the Hos pital of the University of Pennsylvania or the University of Cincinnati Hos pital. The charts were reviewed for neurological complications, systemic co mplications, and adherence to the National Institutes of Neurological Disor ders and Stroke (NINDS) protocol for AIS management. Results-No major neurological or systemic complications occurred. Four pati ents had hypertension warranting treatment, 3 patients experienced motion s ickness, 1 patient developed a transient confusional state, and patient exp erienced minor systemic bleeding. Four NINDS protocol violations occurred, all related to blood pressure management. Conclusions-In this small series, AMT of AIS patients after thrombolysis wa s not associated with any major neurological or systemic complications. Fli ght crew education on the NINDS AIS protocol is essential in limiting the n umber of protocol violations. AMT of patients with AIS provides fast and sa fe access to tertiary centers that can provide state of the art stroke ther apy.