Specialized ambulance increases thrombolysis for stroke patients in 'golden hour'
- Date:
- November 17, 2014
- Source:
- The JAMA Network Journals
- Summary:
- A specialized ambulance staffed with a neurologist and equipped with a computed tomographic scanner helped increase the percentage of patients with stroke who received thrombolysis to break down blood clots within the so-called 'golden hour,' the 60 minutes from time of symptom onset to treatment when treatment may be most effective, according to a study.
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A specialized ambulance staffed with a neurologist and equipped with a computed tomographic scanner helped increase the percentage of patients with stroke who received thrombolysis to break down blood clots within the so-called 'golden hour,' the 60 minutes from time of symptom onset to treatment when treatment may be most effective, according to a study published online by JAMA Neurology.
The time to treatment with tissue plasminogen activator (tPA) to break down blood clots is crucial to how patients fare after acute ischemic stroke. But when prehospital times are added to hospital delays the onset to treatment (OTT) within 60 minutes seems out of reach for most patients. An approach to shorten the OTT is prehospital thrombolysis in a specialized ambulance, according to background information in the study.
Martin Ebinger, M.D., of the Charité-Universitätsmedizin Berlin, Germany, and co-authors examined the achievable rate of golden hour thrombolysis in prehospital care and the effect it had on how patients fared. The authors used data from a study conducted in Berlin where weeks were randomized according to the availability of a stroke emergency mobile unit (STEMO) from May 2011 through January 2013.
Study results indicate there were 3,213 emergency calls for suspected stroke during weeks when STEMO was available and 2,969 calls during control weeks when STEMO was not available. Overall, 200 of 614 patients with stroke (32.6 percent) received thrombolysis when the STEMO was deployed and 330 of 1,497 patients (22 percent) received thrombolysis in conventional care. Median OTT was 24.5 minutes shorter after STEMO deployment compared with conventional care. In all ischemic strokes, the rate of golden hour thrombolysis increased from 16 of 1,497 patients (1.1 percent) during conventional care to 62 of 614 (10.1 percent) after STEMO deployment. The median OTT was 50 minutes in golden hour thrombolysis vs. 105 minutes in all other thrombolysis. Patients with golden hour thrombolysis had no higher risks for seven- or 90-day mortality compared with patients with longer OTT and were more likely to be discharged home.
"The use of STEMO increases the percentage of patients receiving thrombolysis within the golden hour. Golden hour thrombolysis entails no risk to the patients' safety and is associated with better short-term outcomes," study notes.
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Materials provided by The JAMA Network Journals. Note: Content may be edited for style and length.
Journal Reference:
- Martin Ebinger, Alexander Kunz, Matthias Wendt, Michal Rozanski, Benjamin Winter, Carolin Waldschmidt, Joachim Weber, Kersten Villringer, Jochen B. Fiebach, Heinrich J. Audebert. Effects of Golden Hour Thrombolysis. JAMA Neurology, 2014; DOI: 10.1001/jamaneurol.2014.3188
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