{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:13:24Z","timestamp":1788416004449,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Stroke"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Oahu large vessel occlusion (LVO) bypass protocol is a real-world island-wide EMS initiative designed to identify patients with suspected LVOs in the field and triage them directly to a Comprehensive Stroke Center (CSC) for endovascular therapy (EVT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective preimplementation-postimplementation study was conducted to investigate the impact of the bypass protocol on endovascular treatment times and patient outcomes between January 1, 2017 to January 1, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 351 patients met inclusion criteria (102 patients pre-bypass vs. 249 patients post-bypass). In an interrupted time series analysis, there was a sustained 66-min reduction in onset-to-CSC door time (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0046), and a 41-min reduction in onset-to-reperfusion time (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.08) in the post-bypass period with no changes in temporal trends. Interfacility transfers for EVT declined 5-fold (55.9% to 11.6%;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) with no delay in onset-to-thrombolytic time (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.13). In multivariate logistic regression modeling, longer onset-to-reperfusion times were independently associated with worse clinical outcomes, where every 30-min delay increased the odds of a higher 90-day mRS score by 6% (OR 1.062, 95% CI 1.001\u20131.125,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.033). The post-bypass era, itself, however, was not associated with improved 90-day good outcomes (mRS 0\u20132: 40.2% vs. 44.6%; adjusted OR 0.98 [95% CI, 0.57\u20131.69];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.93) or a shift in 90-day mRS disability (adjusted OR 0.93 [0.60\u20131.41];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.72), though a nonsignificant trend toward improved 90-day excellent outcomes was observed (mRS 0\u20131: 23.5% vs. 34.5%; unadjusted OR 1.75 [1.01\u20132.90],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.045; adjusted OR 1.51 [0.84\u20132.72],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.17).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of a system-wide EMS LVO bypass protocol successfully reduced onset-to-door and onset-to-reperfusion times within a uniquely closed catchment geography. The impact on clinical outcomes, however, remains to be seen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fstro.2026.1903852","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:22:15Z","timestamp":1788412935000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reducing onset-to-door times through the implementation of a prehospital large vessel occlusion bypass protocol: the Oahu experience"],"prefix":"10.3389","volume":"5","author":[{"given":"Chung-Huan","family":"Sun","sequence":"first","affiliation":[{"name":"University of Hawai'i at Manoa John A Burns School of Medicine","place":["Honolulu, HI, United States"]},{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Chun","sequence":"additional","affiliation":[{"name":"University of Hawai'i at Manoa John A Burns 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States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand","family":"Hui","sequence":"additional","affiliation":[{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rony","family":"Salem","sequence":"additional","affiliation":[{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangxiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Galanis","sequence":"additional","affiliation":[{"name":"State of Hawaii Department of Health","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Koenig","sequence":"additional","affiliation":[{"name":"University of Hawai'i at Manoa John A Burns School of Medicine","place":["Honolulu, HI, United States"]},{"name":"The Queen's Medical Center","place":["Honolulu, HI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1001\/jamaneurol.2021.1055","article-title":"Healthy life-year costs of treatment speed from arrival to endovascular thrombectomy in patients with ischemic stroke: a meta-analysis of individual patient data from 7 randomized clinical trials","volume":"78","author":"Almekhlafi","year":"2021","journal-title":"JAMA 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