Mattila O S, Harve H, Pihlasviita S, Ritvonen J, Sibolt G, Pystynen M, Strbian D, Curtze S, Kuisma M, Tatlisumak T, Lindsberg P J
Neurology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Molecular Neurology, Research Programs Unit, University of Helsinki, Helsinki, Finland.
Acta Neurol Scand. 2017 Jul;136(1):17-23. doi: 10.1111/ane.12687. Epub 2016 Sep 18.
Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach.
Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique. Time delays, sample quality, and logistics were investigated between May 20, 2013 and May 19, 2014.
Prehospital blood sampling and study recruiting were successfully performed for 430 thrombolysis candidates, of which 50% had ischemic stroke, 14.4% TIA, 13.5% hemorrhagic stroke, and 22.1% stroke mimics. A total of 66.3% of all samples were collected during non-office hours. The median (interquartile range) emergency call to prehospital sample time was 33 minutes (25-41), and the median time from reported symptom onset or wake-up to prehospital sample was 53 minutes (38-85; n=394). Prehospital sampling was performed 31 minutes (25-42) earlier than hospital admission blood sampling and 37 minutes (30-47) earlier than admission neuroimaging. Hemolysis rate in serum and plasma samples was 6.5% and 9.3% for EMS samples, and 0.7% and 1.6% for admission samples.
Prehospital biomarker sampling can be implemented in all EMS units and provides a median timesaving of more than 30 minutes to first blood sample. Large prehospital sample sets will enable development of novel ambulance biomarkers to improve early differential diagnosis and treatment of thrombolysis candidates.
基于血液的生物标志物能够为院前环境中的急性中风患者提供早期且具成本效益的诊断，以支持早期治疗的启动。为推动超急性生物标志物的研发，我们着手开展大规模院前血液采样，并确定该方法的可行性及诊断节省的时间。
赫尔辛基大都市区的紧急医疗服务（EMS）人员接受培训，采用套管适配器技术从溶栓候选患者中采集院前血液样本。在2013年5月20日至2014年5月19日期间，对时间延迟、样本质量和后勤保障进行了调查。
成功为430名溶栓候选患者进行了院前血液采样及研究招募，其中50%为缺血性中风，14.4%为短暂性脑缺血发作（TIA），13.5%为出血性中风，22.1%为疑似中风。所有样本中，66.3%是在非办公时间采集的。从紧急呼叫到院前采样的中位（四分位间距）时间为33分钟（25 - 41），从报告症状发作或醒来至院前采样的中位时间为53分钟（38 - 85；n = 394）。院前采样比入院时血液采样早31分钟（25 - 42），比入院神经影像检查早37分钟（30 - 47）。EMS样本的血清和血浆样本溶血率分别为6.5%和9.3%，入院样本的溶血率分别为0.7%和1.6%。
院前生物标志物采样可在所有EMS单位实施，首次血液采样的中位时间节省超过30分钟。大规模的院前样本集将有助于开发新型救护车生物标志物，以改善溶栓候选患者的早期鉴别诊断和治疗。
