The Norwegian Air Ambulance Foundation, Oslo, Norway.
Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
Eur J Neurol. 2021 Aug;28(8):2488-2496. doi: 10.1111/ene.14877. Epub 2021 May 24.
Acute stroke treatment in mobile stroke units (MSU) is feasible and reduces time-to-treatment, but the optimal staffing model is unknown. We wanted to explore if integrating thrombolysis of acute ischemic stroke (AIS) in an anesthesiologist-based emergency medical services (EMS) reduces time-to-treatment and is safe.
A nonrandomized, prospective, controlled intervention study.
age ≥18 years, nonpregnant, stroke symptoms with onset ≤4 h. The MSU staffing is inspired by the Norwegian Helicopter Emergency Medical Services crew with an anesthesiologist, a paramedic-nurse and a paramedic. Controls were included by conventional ambulances in the same catchment area. Primary outcome was onset-to-treatment time. Secondary outcomes were alarm-to-treatment time, thrombolytic rate and functional outcome. Safety outcomes were symptomatic intracranial hemorrhage and mortality.
We included 440 patients. MSU median (IQR) onset-to-treatment time was 101 (71-155) minutes versus 118 (90-176) minutes in controls, p = 0.007. MSU median (IQR) alarm-to-treatment time was 53 (44-65) minutes versus 74 (63-95) minutes in controls, p < 0.001. Golden hour treatment was achieved in 15.2% of the MSU patients versus 3.7% in the controls, p = 0.005. The thrombolytic rate was higher in the MSU (81% vs 59%, p = 0.001). MSU patients were more often discharged home (adjusted OR [95% CI]: 2.36 [1.11-5.03]). There were no other significant differences in outcomes.
Integrating thrombolysis of AIS in the anesthesiologist-based EMS reduces time-to-treatment without negatively affecting outcomes. An MSU based on the EMS enables prehospital assessment of acute stroke in addition to other medical and traumatic emergencies and may facilitate future implementation.
移动卒中单元（MSU）中的急性脑卒中治疗是可行的，并且可以减少治疗时间，但最佳人员配备模式尚不清楚。我们想探讨在以麻醉师为基础的紧急医疗服务（EMS）中整合急性缺血性脑卒中（AIS）的溶栓治疗是否可以缩短治疗时间并保证安全。
这是一项非随机、前瞻性、对照干预研究。
年龄≥18 岁，非妊娠，发病症状持续时间≤4 小时。MSU 的人员配备受挪威直升机紧急医疗服务机组人员的启发，包括一名麻醉师、一名护理人员和一名护理人员。对照组是在同一区域内由常规救护车纳入的。主要结局是发病至治疗时间。次要结局是报警至治疗时间、溶栓率和功能结局。安全结局是症状性颅内出血和死亡率。
我们纳入了 440 名患者。MSU 组的中位（IQR）发病至治疗时间为 101（71-155）分钟，而对照组为 118（90-176）分钟，p=0.007。MSU 组的中位（IQR）报警至治疗时间为 53（44-65）分钟，而对照组为 74（63-95）分钟，p<0.001。MSU 组有 15.2%的患者在 1 小时内接受治疗，而对照组为 3.7%，p=0.005。MSU 组的溶栓率更高（81%比 59%，p=0.001）。MSU 组患者出院回家的比例更高（调整后的 OR [95% CI]：2.36 [1.11-5.03]）。在结局方面没有其他显著差异。
在以麻醉师为基础的 EMS 中整合 AIS 的溶栓治疗可以缩短治疗时间，而不会对结局产生负面影响。基于 EMS 的 MSU 除了可以进行其他医疗和创伤急救评估外，还可以对急性脑卒中进行评估，并可能促进未来的实施。
