Prehospital Advanced Diagnostics and Treatment of Acute Stroke: Protocol for a Controlled Intervention Study

Bache, Kristi G; Hov, Maren Ranhoff; Larsen, Karianne; Solyga, Volker; Lund, Christian

doi:10.2196/resprot.8110

Cited by 6 publications

(17 citation statements)

References 33 publications

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“…The primary outcome was to determine the difference in OTT between the intervention and control group. A power analysis (twosample, two-sided, power 0.80) determined a sample size of 86 thrombolyzed patients in each group to confirm a 30-minute difference in OTT [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Safety parameters were reported to an external safety committee of two experienced neurologists. The committee was blinded for study group and could stop the study if they found evidence for an unacceptable increase in SICH (>4%) or deaths [11]. Modified Rankin Scale (mRS) was analyzed as an ordinal scale (0-6) and dichotomized where mRS 0-2 was defined as favorable outcome (functionally independent).…”

Section: Discussionmentioning

confidence: 99%

“…The aim of Treat-NASPP was to explore if IVT administered by an anesthesiologist in an MSU reduces time-to-treatment and is safe [11]. We hypothesized that the model reduces onset-to-treatment time (OTT) with ≥15 minutes without negatively affecting outcomes [11].…”

Section: Introductionmentioning

confidence: 99%

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Ultraearly thrombolysis by an anesthesiologist in a mobile stroke unit: A prospective, controlled intervention study

Larsen

Jæger

Tveit

et al. 2021

Euro J of Neurology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ultraearly thrombolysis by an anesthesiologist in a mobile stroke unit: A prospective, controlled intervention study

Larsen

Jæger

Tveit

et al. 2021

Euro J of Neurology

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“…It was reported that even the most reliable blood gas analyser at that time resulted in technic failure in approximately 20% of all applications [11]. Even when used by trained anaesthesiologists, procedural difficulties were encountered when attempting to draw an arterial blood sample in 10 out of 36 cardiac arrest patients undergoing resuscitation [9]. In a more heterogeneous population of critically ill patients, 34% of the arterial blood gas analyses could not be performed due to technical failure [12].…”

Section: Discussionmentioning

confidence: 99%

“…For many years, blood glucose measurement has been possible in every ambulance in Denmark, and measurements of troponin or lactate can a be performed prehospitally [ 3 , 4 ]. The use of ultrasonography has increased diagnostic accuracy [ 5 – 7 ], and mobile prehospital CT scanners are currently being tested for use in patients with suspected cerebral thrombosis to facilitate immediate prehospital thrombolysis [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of prehospital arterial blood gas measurements – a randomised controlled trial

Zwisler

Zincuk

Bering

et al. 2019

Scand J Trauma Resusc Emerg Med

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BackgroundArterial blood gas analysis is an important diagnostic tool in managing critically ill patients within the hospital. Whether prehospital application of this diagnostic modality contributes to more exact diagnoses and treatments in critically ill prehospital patients is unknown. The aim of this study was to establish whether access to arterial blood gas analysis increased the prehospital diagnostic accuracy of prehospital anaesthesiologists. Furthermore, we investigated whether prehospital blood gas analysis resulted in therapeutic interventions that would not have been carried out if the arterial blood gas analyser had not been available.MethodsIn a prospective randomised study, two groups of prehospital adult patients with acute critical illness were compared. All patients received standard prehospital care. In the intervention group, an arterial blood gas sample was analysed prehospitally. The primary outcome was the impact of blood gas analysis on the accuracy of prehospital diagnoses. Furthermore, we registered any therapeutic interventions that were carried out as a direct result of the blood gas analysis.ResultsA total of 310 patients were included in the study. Eighty-eight of these patients were subsequently excluded, primarily due to difficulties in obtaining post hoc consent or venous sampling or other technical difficulties. A total of 102 patients was analysed in the arterial blood gas group (ABG group), while 120 patients were analysed in the standard care group (noABG group). In 78 of the 102 patients in the ABG group, the prehospital physician reported that ABG analysis increased their perceived diagnostic precision. In 81 cases in the noABG group, the lack of arterial blood gas analysis was perceived to have decreased diagnostic accuracy. The claim that ABG analysis increased diagnostic accuracy could, however, not be substantiated as there was no difference in the number of un-specific diagnoses between the groups.Blood gas analysis increased the probability of targeting specific prehospital therapeutic interventions and led to 159 interventions, including intubation, ventilation and/or upgrading the level of urgency, in 71 ABG-group patients (p < 0.001).ConclusionAlthough prehospital arterial blood gas analysis did not improve the accuracy of the prehospital diagnoses assigned to patients, it significantly increased the quality of treatment provided to patients with acute critical illness.Trial registrationClinicalTrials.gov, NCT03006692, retrospectively registered six months after first patient entry.

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Improving Stroke Treatment and Outcomes With Mobile Stroke Units

Bache

Grotta

2021

JAMA

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Prehospital Advanced Diagnostics and Treatment of Acute Stroke: Protocol for a Controlled Intervention Study

Abstract: ClinicalTrials.gov NCT03158259; https://clinicaltrials.gov/show/NCT03158259 (Archived by WebCite at http://www.webcitation.org/6wxNEUMUD).

Cited by 6 publications

References 33 publications

Ultraearly thrombolysis by an anesthesiologist in a mobile stroke unit: A prospective, controlled intervention study

Ultraearly thrombolysis by an anesthesiologist in a mobile stroke unit: A prospective, controlled intervention study

Diagnostic value of prehospital arterial blood gas measurements – a randomised controlled trial

Improving Stroke Treatment and Outcomes With Mobile Stroke Units

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