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Ultraearly thrombolysis by an anesthesiologist in a mobile stroke unit: A prospective, controlled intervention study
Author(s) -
Larsen Karianne,
Jæger Henriette S.,
Tveit Lars H.,
Hov Maren R.,
Thorsen Kjetil,
Røislien Jo,
Solyga Volker,
Lund Christian G.,
Bache Kristi G.
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14877
Subject(s) - medicine , thrombolysis , stroke (engine) , emergency medicine , emergency medical services , staffing , prospective cohort study , randomized controlled trial , anesthesia , myocardial infarction , engineering , mechanical engineering , nursing
Background 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. Methods A nonrandomized, prospective, controlled intervention study. Inclusion criteria: 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. Results 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. Conclusions 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.