Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, and Hennepin County Medical Center, Minneapolis, Minnesota.
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):e42-5. doi: 10.1016/j.jstrokecerebrovasdis.2012.03.018. Epub 2012 May 8.
The "drip and ship" paradigm among acute ischemic stroke (AIS) patients has resulted in expansion of thrombolytic treatment in patients eligible for intravenous (IV) recombinant tissue plasminogen activator (rt-PA). It remains controversial whether the settings within the emergency medical services (EMS) transport are adequate for IV rt-PA infusion. We sought to determine EMS adherence to guidelines during the transport of drip and ship AIS patients treated with IV rt-PA while being transferred to comprehensive stroke centers (CSCs) and the effect of nonadherence on outcome upon discharge.
A retrospective evaluation of patients transferred to our CSC was conducted to determine the rates of adherence to quality parameters during EMS transport with infusion of IV rt-PA. Favorable outcome was defined as modified Rankin Scale (mRS) score ≤ 1 upon discharge.
Among the 40 patients studied (55% men; mean age 71.9 ± 13.9 years), 38 patients received vital sign monitoring at 10- to 20-minute intervals. The mean transit time was 37.7 ± 20.2 minutes. Of the 39 patients with blood pressure (BP) monitoring, 7 patients had at least 1 episode of BP elevation above the recommended parameters (>180/105 mm Hg); only 1 of those was treated with an antihypertensive agent. Five of the 40 patients were considered to have worsened between the outside ED and CSC ED evaluations without IV rt-PA discontinuation during transfer. The rate of favorable outcome of patients who had interim neurologic deterioration without discontinuation of IV rt-PA or BP >180/105 mm Hg without antihypertensive treatment was similar to those who experienced neither event (41.7% and 35.7%; P = .736).
Efforts are required to improve EMS adherence to guidelines in patients receiving IV rt-PA during EMS transport in anticipation of broader use of the "drip and ship" paradigm.
急性缺血性脑卒中（AIS）患者的“滴注和转运”模式导致了适合静脉内（IV）重组组织型纤溶酶原激活剂（rt-PA）治疗的患者溶栓治疗的扩大。在紧急医疗服务（EMS）转运过程中，IV rt-PA 输注的环境是否合适仍存在争议。我们旨在确定在将接受 IV rt-PA 治疗的滴注和转运 AIS 患者转运至综合卒中中心（CSC）期间，EMS 对指南的遵循情况，以及不遵守指南对出院时结局的影响。
对转运至我们 CSC 的患者进行回顾性评估，以确定在 IV rt-PA 输注过程中，EMS 转运过程中对质量参数的遵守情况。良好的结局定义为出院时改良 Rankin 量表（mRS）评分≤1。
在研究的 40 例患者中（55%为男性；平均年龄 71.9±13.9 岁），38 例患者每 10-20 分钟监测一次生命体征。平均转运时间为 37.7±20.2 分钟。在 39 例有血压（BP）监测的患者中，有 7 例至少有 1 次 BP 升高超过推荐参数（＞180/105mmHg）；只有 1 例接受了降压药物治疗。在转运过程中没有停止 IV rt-PA 输注的情况下，40 例患者中有 5 例在外部急诊科和 CSC 急诊科评估之间病情恶化。在没有中断 IV rt-PA 或 BP＞180/105mmHg 且没有降压治疗的情况下出现中期神经功能恶化的患者中，结局良好的比例与未发生上述事件的患者相似（41.7%和 35.7%；P=0.736）。
需要努力提高 EMS 对接受 IV rt-PA 治疗的患者在 EMS 转运期间对指南的遵循程度，以期待更广泛地使用“滴注和转运”模式。
