Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany.
Neurology. 2013 Jan 8;80(2):163-8. doi: 10.1212/WNL.0b013e31827b90e5. Epub 2012 Dec 5.
Beneficial effects of IV tissue plasminogen activator (tPA) in acute ischemic stroke are strongly time-dependent. In the Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke (PHANTOM-S) study, we undertook stroke treatment using a specialized ambulance, the stroke emergency mobile unit (STEMO), to shorten call-to-treatment time.
The ambulance was staffed with a neurologist, paramedic, and radiographer and equipped with a CT scanner, point-of-care laboratory, and a teleradiology system. It was deployed by the dispatch center whenever a specific emergency call algorithm indicated an acute stroke situation. Study-specific procedures were restricted to patients able to give informed consent. We report feasibility, safety, and duration of procedures regarding prehospital tPA administration.
From February 8 to April 30, 2011, 152 subjects were treated in STEMO. Informed consent was given by 77 patients. Forty-five (58%) had an acute ischemic stroke and 23 (51%) of these patients received tPA. The mean call-to-needle time was 62 minutes compared with 98 minutes in 50 consecutive patients treated in 2010. Two (9%) of the tPA-treated patients had a symptomatic intracranial hemorrhage and 1 of these patients (4%) died in hospital. Technical failures encountered were 1 CT dysfunction and 2 delayed CT image transmissions.
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.
静脉注射组织型纤溶酶原激活剂（tPA）对急性缺血性脑卒中的有益作用具有很强的时间依赖性。在 Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke（PHANTOM-S）研究中，我们使用专门的救护车-卒中急救移动单元（STEMO）来缩短呼叫至治疗时间，开展卒中治疗。
救护车配备了神经科医生、护理人员和放射技师，并配备了 CT 扫描仪、即时护理实验室和远程放射学系统。每当特定的紧急呼叫算法表明出现急性卒中情况时，调度中心就会部署这辆救护车。特定于该研究的程序仅限于能够给予知情同意的患者。我们报告了关于院前 tPA 给药的可行性、安全性和程序持续时间。
从 2011 年 2 月 8 日至 4 月 30 日，152 名患者在 STEMO 接受了治疗。77 名患者给予了知情同意。45 名（58%）患者患有急性缺血性脑卒中，其中 23 名（51%）患者接受了 tPA 治疗。平均呼叫至用药时间为 62 分钟，而 2010 年连续 50 名接受治疗的患者为 98 分钟。2 名（9%）接受 tPA 治疗的患者出现症状性颅内出血，其中 1 例（4%）患者在院内死亡。遇到的技术故障包括 1 次 CT 功能障碍和 2 次延迟的 CT 图像传输。
数据表明 STEMO 中的院前卒中护理是可行的。目前尚未提出安全问题。这种使用院前 tPA 的新方法可能有助于减少呼叫至用药时间，但这目前正在一项前瞻性对照研究中进行审查。
