Prehospital stroke diagnosis and treatment in ambulances and helicopters—a concept paper

Hölscher, Thilo; Dunford, James V.; Schlachetzki, Felix; Boy, Sandra; Hemmen, Thomas; Meyer, Brett C.; Serra, John; Powers, Jeff; Voie, Arne

doi:10.1016/j.ajem.2012.12.030

Cited by 27 publications

(25 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In one German study, transcranial ultrasound used in a prehospital setting demonstrated a sensitivity of 78% and specificity of 98% for the diagnosis of MCA or internal carotid artery occlusion in comparison with CTA/MRA performed at receiving hospitals 74. In addition, investigations are continuing into the use of ultrasound, with or without microbubble contrast administration, to assist in mechanical clot dissolution or aid the cerebral microcirculation, potentially providing some degree of prehospital clot ‘conditioning’ or neuroprotection before definitive treatment 73. An advantage of transcranial ultrasound includes its portability, allowing application in air- and ground-based transport 73.…”

Section: Prehospital Efficiency Opportunities In Elvo Strokementioning

confidence: 99%

“…In addition, investigations are continuing into the use of ultrasound, with or without microbubble contrast administration, to assist in mechanical clot dissolution or aid the cerebral microcirculation, potentially providing some degree of prehospital clot ‘conditioning’ or neuroprotection before definitive treatment 73. An advantage of transcranial ultrasound includes its portability, allowing application in air- and ground-based transport 73. Disadvantages include a requirement for intensive personnel training, with direct physician supervision either physically or electronically, and the limitations imposed by cranial bony imaging windows and the inability to diagnose hemorrhage.…”

Section: Prehospital Efficiency Opportunities In Elvo Strokementioning

confidence: 99%

See 1 more Smart Citation

Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery

Pride

Fraser

Gupta

et al. 2016

J NeuroIntervent Surg

View full text Add to dashboard Cite

Section: Prehospital Efficiency Opportunities In Elvo Strokementioning

confidence: 99%

Section: Prehospital Efficiency Opportunities In Elvo Strokementioning

confidence: 99%

Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery

Pride

Fraser

Gupta

et al. 2016

J NeuroIntervent Surg

View full text Add to dashboard Cite

“…The ultrasound scanner can be very small and easy to carry, demonstrating a potential future trend in equipment [31,32].…”

Section: Strokementioning

confidence: 99%

mHealth For Aging China: Opportunities and Challenges

Sun¹,

Guo²,

Wang³

et al. 2016

Aging and disease

107

View full text Add to dashboard Cite

The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries.

show abstract

“…Being noninvasive, nonradiating and less expensive than other imaging techniques, ultrasound has been evaluated in the prehospital setting in various conditions [76,77,78]. Its feasibility was firstly documented in the Regensburg stroke mobile project [77].…”

Section: New Developments and Future Conceptsmentioning

confidence: 99%

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

et al. 2014

View full text Add to dashboard Cite

Background: The global burden of stroke is immense, both in medical and economic terms. With the aging population and the ongoing industrialization of the third world, stroke prevalence is expected to increase and will have a major effect on national health expenditures. Currently, the medical treatment for acute ischemic stroke is limited to intravenous recombinant tissue plasminogen activator (IV r-tPA), but its time dependency leads to low utilization rates in routine clinical practice. Prehospital delay contributes significantly to delayed or missed treatment opportunities in acute stroke. State-of-the-art acute stroke care, starting in the prehospital phase, could thereby reduce the disease burden and its enormous financial costs. Summary: The first part of this review focuses on current education measures for the general public, the emergency medical services (EMS) dispatchers and paramedics. Although much has been expected of these measures to improve stroke care, no major effects on prehospital delay or missed treatment opportunities have been demonstrated over the years. Most interventional studies showed little or no effect on the onset-to-door time, IV r-tPA utilization rates or outcome, except for prenotification of the receiving hospital by the EMS. No data are currently available on the cost-effectiveness of these commonly used measures. In the second part, we discuss new developments for the improvement of prehospital stroke diagnosis and treatment which could open new perspectives in the nearby future. These include the implementation of prehospital telestroke and the deployment of mobile stroke units. These approaches may improve patient care and could serve as a platform for prehospital clinical trials. Other opportunities include the implementation of noninvasive diagnostics (like transcranial ultrasound and blood-borne biomarkers) and the reevaluation of neuroprotective strategies in the prehospital phase. Key Messages: Timely initiation of treatment can effectively reduce the medical and economic burden of stroke and should begin with optimal prehospital stroke care. For this, prehospital telemedicine is a particularly attractive approach because it is a scalable solution that has the potential to rapidly optimize acute stroke care at limited cost.

show abstract

Prehospital stroke diagnosis and treatment in ambulances and helicopters—a concept paper

Cited by 27 publications

References 54 publications

Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery

Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery

mHealth For Aging China: Opportunities and Challenges

Prehospital Stroke Care: Limitations of Current Interventions and Focus on New Developments

Contact Info

Product

Resources

About