Prehospital stroke care

Abstract

Brain cells die rapidly after stroke and any effective treatment must start as early as possible. In clinical routine, the tight time-outcome relationship continues to be the major limitation of therapeutic approaches: thrombolysis rates remain low across many countries, with most patients being treated at the late end of the therapeutic window. In addition, there is no neuroprotective therapy available, but some maintain that this concept may be valid if administered very early after stroke. Recent innovations have opened new perspectives for stroke diagnosis and treatment before the patient arrives at the hospital. These include stroke recognition by dispatchers and paramedics, mobile telemedicine for remote clinical examination and imaging, and integration of CT scanners and point-of-care laboratories in ambulances. Several clinical trials are now being performed in the prehospital setting testing prehospital delivery of neuroprotective, antihypertensive, and thrombolytic therapy. We hypothesize that these new approaches in prehospital stroke care will not only shorten time to treatment and improve outcome but will also facilitate hyperacute stroke research by increasing the number of study participants within an ultra-early time window. The potentials, pitfalls, and promises of advanced prehospital stroke care and research are discussed in this review. Neurology â 2013;81:501-508

Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…31 The new 4G technology with higher bandwidth and optional prioritization in public mobile networks appears to be more appropriate for the use of ambulance-based telestroke applications. 13,32 A streamlined unassisted telestroke scale 33 was evaluated with healthy volunteers mimicking stroke syndromes during ambulance transportation 34 and demonstrated sufficient stability in a moving ambulance using 4G connectivity. Further testing in actual acute stroke transport situations is needed to assess this promising approach.…”

mHealth For Aging China: Opportunities and Challenges

“…The available evidence has demonstrated that mHealth could optimize the care and recovery of patients with myocardial infarction and stroke, aid in the screening and management of cognitive impairment, and facilitate sleep monitoring and intervention [18][19]. Moreover, mHealth may offer solutions to accessible and good quality individualized health management services to improve the management of chronic diseases through remote monitoring and enhance awareness and diseases-specific education.…”

“…Hence, patients' stroke type can be quickly and accurately diagnosed, and thrombolytic therapy can be used during the transport process [26]. According to a random survey of the equipment, the implementation of STEMO pre-hospital treatment can shorten median medical decision-making time from 76 minutes to 35 minutes [19]. Obviously, this type of luxury equipment is not suitable for developing countries.…”

Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy

“…However, significant limitations exist with regard to prehospital management, timely selection for intravenous tPA or endovascular therapy, and multidisciplinary coordination of posttreatment stroke and ICU care. 4,6 Perhaps most importantly, both intravenous thrombolysis and mechanical revascularization target vessel recanalization rather than tissue reperfusion and are highly dependent on time.…”

“…However, significant limitations exist with regard to prehospital management, timely selection for intravenous tPA or endovascular therapy, and multidisciplinary coordination of posttreatment stroke and ICU care. 4,6 Perhaps most importantly, both intravenous thrombolysis and mechanical revascularization target vessel recanalization rather than tissue reperfusion and are highly dependent on time.Despite recent advances, the rates of functional independence (14%-58%) following mechanical thrombectomy are poor compared with the efficient rates of recanalization (60%-90%). 7,34 The mechanism underlying this paradox remains elusive.…”