Data_Sheet_1_Strategies to reduce delays in delivering mechanical thrombectomy for acute ischaemic stroke – an umbrella review.docx

BackgroundMechanical thrombectomy is a time-sensitive treatment, with rapid initiation and reduced delays being associated with better patient outcomes. Several systematic reviews reported on various interventions to address delays. Hence, we performed an umbrella review of systematic reviews to summarise the current evidence.
MethodsMedline, Embase, Cochrane Library and JBI were searched for published systematic reviews. Systematic Reviews that detailed outcomes related to time-to-thrombectomy or functional independence were included. Methodological quality was assessed using the JBI critical appraisal tool by two independent reviewers.
ResultsA total of 17 systematic reviews were included in the review. These were all assessed as high-quality reviews. A total of 13 reviews reported on functional outcomes, and 12 reviews reported on time-to-thrombectomy outcomes. Various interventions were identified as beneficial. The most frequently reported beneficial interventions that improved functional and time-related outcomes included: direct-to-angio-suite and using a mothership model (compared to drip-and-ship). Only a few studies investigated other strategies including other pre-hospital and teamwork strategies.
ConclusionOverall, there were various strategies that can be used to reduce delays in the delivery of mechanical thrombectomy with different effectiveness. The mothership model appears to be superior to the drip-and-ship model in reducing delays and improving functional outcomes. Additionally, the direct-to-angiosuite approach appears to be beneficial, but further research is required for broader implementation of this approach and to determine which groups of patients would benefit the most.

背景：机械取栓术（mechanical thrombectomy）是一项时间敏感性治疗手段，快速启动治疗并缩短延迟时长与更优的患者预后密切相关。目前已有多项系统综述探讨了各类可减少治疗延迟的干预措施。因此，本研究开展了一项系统综述的伞状综述（umbrella review），以总结当前的循证证据。
方法：检索Medline、Embase、考克兰图书馆（Cochrane Library）以及JBI（Joanna Briggs Institute）数据库中已发表的系统综述。纳入详细报道了至机械取栓的时间或功能独立性相关结局的系统综述。由2名独立评价者采用JBI关键评价工具（JBI critical appraisal tool）对纳入研究的方法学质量进行评估。
结果：本伞状综述共纳入17项系统综述，所有纳入研究均被评为高质量综述。其中13项综述报道了功能结局，12项综述报道了至机械取栓的时间相关结局。研究识别出多种有益的干预措施。最常被报道的可改善功能结局与时间相关结局的有益干预措施包括：直达血管造影手术室（direct-to-angio-suite）以及采用母船模式（mothership model，相较于溶栓转运模式drip-and-ship）。仅有少量研究探讨了其他策略，包括其他院前干预策略与团队协作策略。
结论：总体而言，目前存在多种可缩短机械取栓治疗延迟的策略，且各类策略的有效性存在差异。母船模式在缩短治疗延迟、改善功能结局方面似乎优于溶栓转运模式。此外，直达血管造影手术室的策略似乎具有临床获益，但该策略的更广泛应用，以及明确获益最显著的患者群体，仍需开展进一步研究。