Clinical Practice Guidelines for the Prehospital Stage of Acute Stroke in Korea II : Transport Decisions for Patients with Acute Ischemic Stroke
- Author:
Jae Sang OH
1
;
Yuna JO
;
Jong Min LEE
;
Hong Suk AHN
;
Jung-Jae KIM
;
Kyoung Min JANG
;
Gi-Yong YUN
;
Jang Hun KIM
;
Dongwook SEO
;
Hyeong Jin LEE
;
Jinwoo JEONG
;
Kyoung-Chul CHA
;
Yong Soo CHO
;
Su Jin KIM
;
Jongkyu PARK
;
Won-Sang CHO
;
Hoon KIM
;
Young Woo KIM
;
Seung Hun SHEEN
;
Sang Weon LEE
;
Jae Whan LEE
;
Tae Gon KIM
;
Sung-kon HA
;
Sukh Que PARK
;
Soon Chan KWON
Author Information
- Publication Type:Review Article
- From:Journal of Korean Neurosurgical Society 2026;69(1):23-34
- CountryRepublic of Korea
- Language:English
- Abstract: The mothership (MS) model, where patients are directly transferred to a thrombectomy-capable center, and the drip-and-ship (DS) model, where thrombolysis is initiated at the nearest primary stroke center before transfer for thrombectomy, are the primary transport modes for patients with stroke. We aimed to establish guidelines for selecting the appropriate transfer strategy based on emergent large vessel occlusion (LVO). We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer three Population, Intervention, Comparison, and Outcome questions comparing MS and DS models. The risk of bias was assessed using the Newcastle-Ottawa Scale. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcomes, mortality, and successful recanalization. Twenty-six non-randomized controlled studies showed that the MS model improved good functional outcomes by approximately 14% compared with the DS model (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00–1.30). Fifteen studies reported that mortality in the MS and DS models showed no significant differences (OR, 0.97; 95% CI, 0.84–1.11). Twenty-four studies revealed no significant difference in successful recanalization between the MS and DS models (OR, 0.87; 95% CI, 0.68–1.10). The MS model should be considered first to improve the functional outcome of patients with LVO. However, if thrombectomy cannot be performed immediately after thrombolysis, or if a thrombectomy-enabled hospital is not nearby, the DS model should be considered by stroke specialists depending on transportation time and regional factors. We suggest a mixed approach with the DS model based on specific circumstances or regions to ensure the optimum treatment of patients with acute ischemic stroke (AIS). Appropriate transport for patients with LVO improves the prognosis of AIS.
