• Neurology · Jan 2013

    Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study.

    • Joachim E Weber, Martin Ebinger, Michal Rozanski, Carolin Waldschmidt, Matthias Wendt, Benjamin Winter, Philipp Kellner, André Baumann, Jochen B Fiebach, Kersten Villringer, Sabina Kaczmarek, Matthias Endres, Heinrich J Audebert, and STEMO-Consortium.
    • Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany.
    • Neurology. 2013 Jan 8;80(2):163-8.

    ObjectiveBeneficial 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.MethodsThe 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.ResultsFrom 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.ConclusionsThe 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.

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