Prehospital thrombolysis in acute stroke

Weber, Joachim E.; Ebinger, Martin; Różański, Michał; Waldschmidt, Carolin; Wendt, Matthias; Winter, Benjamin; Kellner, Philipp; Baumann, André; Fiebach, Jochen B.; Villringer, Kersten; Kaczmarek, Sabina; Endres, Matthias; Audebert, Heinrich J.

doi:10.1212/wnl.0b013e31827b90e5

Cited by 141 publications

(112 citation statements)

References 28 publications

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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%

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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Section: Discussionmentioning

confidence: 99%

Prehospital Thrombolysis: A Manual from Berlin

Ebinger¹,

Lindenlaub²,

Kunz³

et al. 2013

JoVE

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show abstract

“…Subsequently, this system has been adopted in the official Neurosurgical Society of Australasia (NSA) and Royal Australasian College of Surgeons (RACS) neurotrauma guidelines [77]. This system has proved its validity in stroke patients [78,79] and in treating myocardial infarctions [80].…”

Section: Triage Of the Futurementioning

confidence: 99%

Prehospital Triage and Emergency Room Care in TBI

Chmayssani¹

2014

Emergency Medicine

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“…The pilot study showed encouraging results for treatment safety and number of prehospital tPA applications (23 treatments within 52 days). 6 The results from a large controlled study are expected in 2013. 51 The different approaches of pre-and in-hospital stroke management are shown in figure 2.…”

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confidence: 95%

“…These innovations include the identification of stroke patients by dispatchers and by paramedics; collection and processing of informed consent to study participation via mobile cell phone and video; installation of modern diagnostics such as point-of-care laboratories, duplex sonography, and brain CT scanners in ambulances; and the integration of remote clinical examination and imaging review via mobile telemedicine as used for prehospital stroke thrombolysis in 2 current projects. 6,7 As physicians who are involved in prehospital stroke research and whose aim is to further improve time-critical stroke treatments, we discuss the potentials, pitfalls, and promises of advanced prehospital stroke care and research.…”

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confidence: 99%

Prehospital stroke care

et al. 2013

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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

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Prehospital thrombolysis in acute stroke

Abstract: The data suggest that prehospital stroke care in STEMO is feasible. No safety concerns have been raised so far. This new approach using prehospital tPA may be effective in reducing call-to-needle times, but this is currently being scrutinized in a prospective controlled study.

Cited by 141 publications

References 28 publications

Prehospital Thrombolysis: A Manual from Berlin

Prehospital Thrombolysis: A Manual from Berlin

Prehospital Triage and Emergency Room Care in TBI

Prehospital stroke care

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