ABSTRACT NUMBER: ESOC2026A2311 IMPACT OF HELICOPTER TRANSPORT ON FUNCTIONAL OUTCOME IN PATIENTS WITH SUSPECTED LARGE VESSEL OCCLUSION STROKE

Abstract Background and aims Prehospital triage of patients with suspected large vessel occlusion (LVO) stroke is crucial for timely recanalization and favorable functional outcome. Selecting the optimal transport strategy (mothership vs. drip-and-ship) and transport modality remains challenging, particularly in regions with heterogeneous geography and stroke unit workflows. This study aimed to evaluate the influence of helicopter transport on prehospital triage by quantifying its impact on the probability of good functional outcome. Methods A previously described conditional probability model was applied to estimate the probability of good functional outcome in patients with suspected LVO stroke in a district of South Baden, Germany. The model incorporated prehospital triage strategy, transport modality (ground vs. helicopter), time from symptom onset to emergency call, and heterogeneity in clinical workflows among participating stroke units. The impact of helicopter transport on triage-dependent outcome probabilities was assessed. Regionally superior triage strategies were visualized using a high-resolution spatial grid map. Results Helicopter transport substantially increased the absolute probability of good functional outcome in geographically remote areas and significantly changed prehospital triage decision thresholds. Its use reduced the spatial extent in which the drip-and-ship strategy was superior. The benefit was most pronounced in regions with prolonged ground transport times and extended in-hospital workflows at primary stroke centers. Overall, helicopter availability modified the superior triage strategy across large parts of the region. Conclusions Helicopter transport significantly influences prehospital triage in suspected LVO stroke. Probability-based models incorporating this modality may enable individualized, geography- and workflow-sensitive triage decisions and optimize regional stroke systems of care. Conflict of interest Max Henningsen: nothing to disclose; Jochen Brich: nothing to disclose