PHANTOM-S: The Prehospital Acute Neurological Therapy and Optimization of           Medical Care in Stroke Patients – Study

Ebinger, Martin; Różański, Michał; Waldschmidt, Carolin; Weber, Joachim E.; Wendt, Matthias; Winter, Benjamin; Kellner, Philipp; Baumann, A.; Malzahn, Uwe; Heuschmann, Peter U.; Fiebach, Jochen B.; Endres, Matthias; Audebert, Heinrich J.

doi:10.1111/j.1747-4949.2011.00756.x

Cited by 69 publications

(46 citation statements)

References 13 publications

(13 reference statements)

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“…The cost-effectiveness and wider applicability of this intervention needs further assessment, including its impact on patient-oriented outcomes. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke CJEM JCMU 2015;17 (6)…”

Section: Resultsmentioning

confidence: 99%

“…This study, the prehospital acute neurological treatment and optimization of medical care in stroke study (PHANTOM-S), 6,7 was preceded by a 3-month pilot study to assess the stroke emergency mobile unit (STEMO) deployment feasibility and safety. This special ambulance carried special equipment (a computed tomography [CT] scanner, point-of-care laboratory, and teleradiology system) and three staff (a paramedic, a neurologist, and a radiology technician).…”

Section: Introductionmentioning

confidence: 99%

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Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial.

Fakhraldeen

Segal

Champlain

2015

CJEM

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Article chosenEbinger M, Winter B, Wendt M, et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014;311(16):1622-31.Clinical questionDoes prehospital thrombolysis in specialized ambulances reduce delay to thrombolysis in acute ischemic stroke?ObjectiveTo determine the effect of prehospital thrombolysis for acute ischemic stroke administered in specialized ambulances on delay in thrombolytic administration, thrombolysis rate, post-thrombolysis intracerebral hemorrhage, and 7-day mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial.

Fakhraldeen

Segal

Champlain

2015

CJEM

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“…Associated with the risk of severe bleeding, the exclusion of intracranial bleeds and other contraindications is mandatory prior to thrombolysis. STEMO is set up to prove that this specific treatment can be safely administered in a prehospital setting and actually safes time compared to regular care 8,11 . First results from 12 prehospital thrombolyses in the Saarland State, Germany, seem promising in this respect 12 .…”

Section: Discussionmentioning

confidence: 99%

“…This special ambulance is equipped with a CT scanner, a point-of-care laboratory and an infrastructure for teleradiological support 7 . It is operated by a highly specialized crew consisting of experienced neurologists, paramedics of the Berlin Fire Brigade, and radiology technicians 8 . To meet the legal requirements and the requirements of the Berlin Medical Board, each neurologist involved completed an additional training in emergency medicine.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Thrombolysis: A Manual from Berlin

Ebinger¹,

Lindenlaub²,

Kunz³

et al. 2013

JoVE

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In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient's medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse).Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.

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“…Research studies are underway in Berlin and Houston to examine the effects of placing CT scanners in ambulances to allow rapid imaging, remote transmission of imaging data for expert review and a thrombolysis decision, so that paramedics can deliver thrombolytic therapy in the ambulance. 41 Ambulance-based CT may eventually facilitate a direct-to-angiographysuite approach for acute ischemic stroke, similar to what is already in place for MI.…”

Section: Minutes Countmentioning

confidence: 99%