Prehospital Thrombolysis: A Manual from Berlin

Ebinger, Martin; Lindenlaub, Sascha; Kunz, Alexander; Różański, Michał; Waldschmidt, Carolin; Weber, Joachim E.; Wendt, Matthias; Winter, Benjamin; Kellner, Philipp; Kaczmarek, Sabina; Endres, Matthias; Audebert, Heinrich J.

doi:10.3791/50534

Cited by 17 publications

(12 citation statements)

References 16 publications

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“…15 Methodologic details of the PHANTOM-S study have been described previously. 16,17 In brief, an ambulance, the stroke emergency mobile unit (STEMO), was equipped with a computed tomographic scanner and point-of-care laboratory. The unit was staffed with a neurologist trained in emergency medicine (including M.E., A.K., M.W., M.R., B.W., C.W., and J.W.…”

Section: Methodsmentioning

confidence: 99%

Effects of Golden Hour Thrombolysis

et al. 2015

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The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the golden hour.OBJECTIVE To determine the achievable rate of golden hour thrombolysis in prehospital care and its effect on outcome. DESIGN, SETTING, AND PARTICIPANTSThe prospective controlled Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke study was conducted in Berlin, Germany, within an established infrastructure for stroke care. Weeks were randomized according to the availability of a specialized ambulance (stroke emergency mobile unit (STEMO) from May 1, 2011, through January 31, 2013. We included 6182 consecutive adult patients for whom a stroke dispatch (44.1% male; mean [SD] age, 73.9 [15.0] years) or regular care (45.0% male; mean [SD] age, 74.2 [14.9] years) were included. INTERVENTIONSThe STEMO was deployed when the dispatchers suspected an acute stroke during emergency calls. If STEMO was not available (during control weeks, when the unit was already in operation, or during maintenance), patients received conventional care. The STEMO is equipped with a computed tomographic scanner plus a point-of-care laboratory and telemedicine connection. The unit is staffed with a neurologist trained in emergency medicine, a paramedic, and a technician. Thrombolysis was started in STEMO if a stroke was confirmed and no contraindication was found. MAIN OUTCOMES AND MEASURESRates of golden hour thrombolysis, 7-and 90-day mortality, secondary intracerebral hemorrhage, and discharge home.RESULTS Thrombolysis rates in ischemic stroke were 200 of 614 patients (32.6%) when STEMO was deployed and 330 of 1497 patients (22.0%) when conventional care was administered (P < .001). Among all patients who received thrombolysis, the proportion of golden hour thrombolysis was 6-fold higher after STEMO deployment (62 of 200 patients [31.0%] vs 16 of 330 [4.9%]; P < .01). Compared with patients with a longer time from symptom onset to treatment, patients who received golden hour thrombolysis had no higher risks for 7-or 90-day mortality (adjusted odds ratios, 0.38 [95% CI, 0.09-1.70]; P = .21 and 0.69 [95% CI, 0.32-1.53]; P = .36) and were more likely to be discharged home (adjusted odds ratio, 1.93 [95% CI, 1.09-3.41]; P = .02). CONCLUSIONS AND RELEVANCEThe use of STEMO increases the percentage of patients receiving thrombolysis within the golden hour. Golden hour thrombolysis entails no risk to the patients' safety and is associated with better short-term outcomes.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01382862

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Section: Methodsmentioning

confidence: 99%

Effects of Golden Hour Thrombolysis

et al. 2015

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“…(Walter et al 2010, Ebinger et al 2013 The concept has proven to be successful in randomized controlled trials (Walter et al 2012, Ebinger et al 2014) and it has deemed as highly cost-effective solution in a large metropolitan setting. However, the concept requires a large and high costs (Gyrd-Hansen et al 2015).…”

Section: Dispatch Time <1 Minutementioning

confidence: 99%

Stroke and the emergency medical services – enhancing performance within the chain of survival

Puolakka

2017

Acta Anaesthesiol Scand

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“…Amobile stroke unit is equipped with CT scanner, point-of- care laboratory, telestroke connectivity, thrombolysis capability, CT technician, EMT with or without a stroke neurologist [72]. Figure 3 shows the interior of a mobile stroke unit.…”

Section: Mobile Stroke Unitmentioning

confidence: 99%

Imaging of prehospital stroke therapeutics

Lin¹,

Sanossian²,

Liebeskind³

2015

Expert Review of Cardiovascular Therapy

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Despite significant quality improvement efforts to streamline in-hospital acute stroke care in the conventional model, there remain inherent layers of treatment delays, which could be eliminated with prehospital diagnostics and therapeutics administered in a mobile stroke unit. Early diagnosis using Telestroke and neuroimaging while in the ambulance may enable targeted routing to hospitals with specialized care, which will likely improve patient outcomes. Key clinical trials in Telestroke, mobile stroke units with prehospital neuroimaging capability, prehospital ultrasound and co-administration of various classes of neuroprotectives, antiplatelets and antithrombin agents with intravenous thrombolysis are discussed in this article.

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Prehospital Thrombolysis: A Manual from Berlin

Cited by 17 publications

References 16 publications

Effects of Golden Hour Thrombolysis

Effects of Golden Hour Thrombolysis

Stroke and the emergency medical services – enhancing performance within the chain of survival

Imaging of prehospital stroke therapeutics

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