title: Effect of helicopter transport on neurological outcomes in a mouse model of embolic stroke with reperfusion: AIR-MICE pilot study.
abstract: BACKGROUND
  Patients often suffer a stroke at a significant distance from a center capable of delivering endovascular therapy, thus requiring rapid transport by helicopter emergency medical services while receiving a recombinant tissue plasminogen activator infusion that was initiated locally. But little is known about how a helicopter flight may impact the safety and efficacy of recombinant tissue plasminogen activator-induced reperfusion and patient outcomes.
  
  
  OBJECTIVE
  To establish a new animal method to address with fidelity the safety and overall effect of helicopter emergency medical services during thrombolysis.
  
  
  METHODS
  Prospective randomized open blinded end-point study of an actual helicopter flight exposure. Adult C57BL/6 male mice were treated with a 10 mg/kg recombinant tissue plasminogen activator infusion two-hours after an embolic middle cerebral artery occlusion. Mice were randomized in pairs to simultaneously receive the infusion during a local helicopter flight or in a ground hangar.
  
  
  RESULTS
  Eighteen mice (nine pairs) were analyzed. The paired t-test analysis showed nonsignificant smaller infarction volumes in the helicopter-assigned animals (mean pair difference 33 mm(3) , P = 0·33). The amount of hemorrhagic transformation between the helicopter and ground groups was 4·08 vs. 4·56 μl, respectively (paired t-test, P = 0·45).
  
  
  CONCLUSIONS
  This study shows that helicopter emergency medical services do not have an inherent adverse effect on outcome in a mouse model of ischemic stroke with reperfusion. These results endorse the safety of the practice of using helicopter emergency medical services in stroke patients. The observed potential synergistic effect of helicopter-induced factors, such as vibration and changes in altitude, with reperfusion merits further exploration in animal experimental models and in stroke patients.
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Enrique C
authors.initials: EC
authors.lastname: Leira
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Asgar
authors.initials: A
authors.lastname: Zaheer
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.|Department of Mechanical and Industrial Engineering, College of Engineering, University of Iowa, Iowa City, IA, USA.|Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schnell
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.|Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Torner
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Heena M
authors.initials: HM
authors.lastname: Olalde
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.|Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Pieper
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.|Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.|Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Ortega-Gutierrez
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Nandakumar
authors.initials: N
authors.lastname: Nagaraja
authors.affiliation: Office of the Institutional Animal Care and Use, University of Iowa, Iowa City, IA, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Marks
authors.affiliation: Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors.forename: Harold P
authors.initials: HP
authors.lastname: Adams
mesh_terms: D000401:Aircraft; D000818:Animals; D020520:Brain Infarction / Q000209:etiology; D004195:Disease Models, Animal; D020244:Infarction, Middle Cerebral Artery / Q000150:complications*; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009422:Nervous System Diseases / Q000209:etiology*; D010865:Pilot Projects; D015424:Reperfusion; D014187:Transportation of Patients; D016896:Treatment Outcome
keywords: animal model; drip & ship; embolic stroke; helicopter emergency medical services; tissue-type plasminogen activator