Ebinger et al report in JAMA the result a specialized ambulance has
in the initiation of treatment in patients with acute ischemic strokes.
Their
study was conducted in Berlin, Germany over a 21 months period between 2011 and
2013 when a Stroke Emergency Mobile (STEMO) unit was dispatched every other week to care of patients with strokes. The STEMO was an ambulance equipped
with a CT scanner, point-of-care laboratory, with telemedicine connection, a physician,
a paramedic and an x-ray technician. Thrombolysis was started before transport
to hospital if ischemic stroke was confirmed and contraindications
excluded. During the study period 6182
adult patients were included.
There was a reduction of 25-minutes
in alarm-to-treatment times for STEMO compared to control weeks. The 25-minute reduction was due to faster
alarm-to-imaging and imaging-to-treatment intervals. Fifty eight percent of
patients were treated within 90 minutes of onset versus 37% in the control. The intervention also resulted in 33%
patients treated with tPA versus 21% in the control. STEMO deployment incurred no increased risk
for intra-cerebral hemorrhage (7/200 vs 22/323); or 7-day mortality (9/199 versus
15/323).
A prior study by Walter et al1
who also used a mobile stroke unit and treated patients with acute ischemic
stroke with tPA safely within 70 to 80 minutes.
The authors conclude the use of ambulance-based thrombolysis resulted in
decreased time to treatment without an increase in adverse events.
1. Walter S, Kostopoulos P, Haass A et al. Diagnosis and treatment of
patients with stroke in a mobile unit versus hospital: a randomized study
controlled trial Lancet Neurol. 2012;11(5):397-404
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