Alexander Kunz1, Martin Ebinger2, Frederik Geisler3, Michal Rozanski2, Carolin Waldschmidt3, Joachim E Weber3, Matthias Wendt3, Benjamin Winter3, Katja Zieschang3, Jochen B Fiebach2, Kersten Villringer2, Hebun Erdur3, Jan F Scheitz3, Serdar Tütüncü3, Kerstin Bollweg2, Ulrike Grittner4, Sabina Kaczmarek5, Matthias Endres6, Christian H Nolte2, Heinrich J Audebert2. 1. Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany. Electronic address: alexander.kunz@charite.de. 2. Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany. 3. Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany. 4. Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany. 5. Berliner Feuerwehr, Berlin Fire Brigade, Berlin, Germany. 6. Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany; Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin Partner Site, Charité-University Medicine Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases, Berlin Partner Site, Charité-University Medicine Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany.
Abstract
BACKGROUND: Specialised CT-equipped mobile stroke treatment units shorten time to intravenous thrombolysis in acute ischaemic stroke by starting treatment before hospital admission; however, direct effects of pre-hospital thrombolysis on clinical outcomes have not been shown. We aimed to compare 3-month functional outcomes after intravenous thrombolysis in patients with acute ischaemic who had received emergency mobile care or and conventional care. METHODS: In this observational registry study, patients with ischaemic stroke received intravenous thrombolysis (alteplase) either within a stroke emergency mobile (STEMO) vehicle (pre-hospital care covering 1·3 million inhabitants of Berlin) or within conventional care (normal ambulances and in-hospital care at the Charité Campus Benjamin Franklin in Berlin). Patient data on treatment, outcome, and demographics were documented in STEMO (pre-hospital) or conventional care (in-hospital) registries. The primary outcome was the proportion of patients who had lived at home without assistance before stroke and had a 3-month modified Rankin Scale (mRS) score of 1 or lower. Our multivariable logistic regression was adjusted for demographics, comorbidities, and stroke severity. This study is registered with ClinicalTrials.gov, number NCT02358772. FINDINGS: Between Feb 5, 2011, and March 5, 2015, 427 patients were treated within the STEMO vehicle and their data were entered into a pre-hospital registry. 505 patients received conventional care and their data were entered into an in-hospital thrombolysis registry. Of these, 305 patients in the STEMO group and 353 in the conventional care group met inclusion criteria and were included in the analysis. 161 (53%) patients in the STEMO group versus 166 (47%) in the conventional care group had an mRS score of 1 or lower (p=0·14). Compared with conventional care, adjusted odds ratios (ORs) for STEMO care for the primary outcome (OR 1·40, 95% CI 1·00-1·97; p=0·052) were not significant. Intracranial haemorrhage (p=0·27) and 7-day mortality (p=0·23) did not differ significantly between treatment groups. INTERPRETATION: We found no significant difference between the proportion of patients with a mRS score of 1 or lower receiving STEMO care compared with conventional care. However, our results suggest that pre-hospital start of intravenous thrombolysis might lead to improved functional outcome in patients. This evidence requires substantiation in future large-scale trials. FUNDING: Zukunftsfonds Berlin, the Technology Foundation Berlin with EU co-financing by the European Regional Development Fund via Investitionsbank Berlin, and the German Federal Ministry for Education and Research via the Center for Stroke Research Berlin.
BACKGROUND: Specialised CT-equipped mobile stroke treatment units shorten time to intravenous thrombolysis in acute ischaemic stroke by starting treatment before hospital admission; however, direct effects of pre-hospital thrombolysis on clinical outcomes have not been shown. We aimed to compare 3-month functional outcomes after intravenous thrombolysis in patients with acute ischaemic who had received emergency mobile care or and conventional care. METHODS: In this observational registry study, patients with ischaemic stroke received intravenous thrombolysis (alteplase) either within a stroke emergency mobile (STEMO) vehicle (pre-hospital care covering 1·3 million inhabitants of Berlin) or within conventional care (normal ambulances and in-hospital care at the Charité Campus Benjamin Franklin in Berlin). Patient data on treatment, outcome, and demographics were documented in STEMO (pre-hospital) or conventional care (in-hospital) registries. The primary outcome was the proportion of patients who had lived at home without assistance before stroke and had a 3-month modified Rankin Scale (mRS) score of 1 or lower. Our multivariable logistic regression was adjusted for demographics, comorbidities, and stroke severity. This study is registered with ClinicalTrials.gov, number NCT02358772. FINDINGS: Between Feb 5, 2011, and March 5, 2015, 427 patients were treated within the STEMO vehicle and their data were entered into a pre-hospital registry. 505 patients received conventional care and their data were entered into an in-hospital thrombolysis registry. Of these, 305 patients in the STEMO group and 353 in the conventional care group met inclusion criteria and were included in the analysis. 161 (53%) patients in the STEMO group versus 166 (47%) in the conventional care group had an mRS score of 1 or lower (p=0·14). Compared with conventional care, adjusted odds ratios (ORs) for STEMO care for the primary outcome (OR 1·40, 95% CI 1·00-1·97; p=0·052) were not significant. Intracranial haemorrhage (p=0·27) and 7-day mortality (p=0·23) did not differ significantly between treatment groups. INTERPRETATION: We found no significant difference between the proportion of patients with a mRS score of 1 or lower receiving STEMO care compared with conventional care. However, our results suggest that pre-hospital start of intravenous thrombolysis might lead to improved functional outcome in patients. This evidence requires substantiation in future large-scale trials. FUNDING: Zukunftsfonds Berlin, the Technology Foundation Berlin with EU co-financing by the European Regional Development Fund via Investitionsbank Berlin, and the German Federal Ministry for Education and Research via the Center for Stroke Research Berlin.
Authors: Martin Ebinger; Bob Siegerink; Alexander Kunz; Matthias Wendt; Joachim E Weber; Eugen Schwabauer; Frederik Geisler; Erik Freitag; Julia Lange; Janina Behrens; Hebun Erdur; Ramanan Ganeshan; Thomas Liman; Jan F Scheitz; Ludwig Schlemm; Peter Harmel; Katja Zieschang; Irina Lorenz-Meyer; Ira Napierkowski; Carolin Waldschmidt; Christian H Nolte; Ulrike Grittner; Edzard Wiener; Georg Bohner; Darius G Nabavi; Ingo Schmehl; Axel Ekkernkamp; Gerhard J Jungehulsing; Bruno-Marcel Mackert; Andreas Hartmann; Jessica L Rohmann; Matthias Endres; Heinrich J Audebert Journal: JAMA Date: 2021-02-02 Impact factor: 56.272
Authors: Claire Vines; Stephanie J Tesseneer; Robert D Cox; Damon A Darsey; Kristin Carbrey; Michael A Puskarich Journal: Acad Emerg Med Date: 2017-11-13 Impact factor: 3.451
Authors: Polly Scutt; Jason P Appleton; Mark Dixon; Lisa J Woodhouse; Nikola Sprigg; Joanna M Wardlaw; Alan A Montgomery; Stuart Pocock; Philip M Bath Journal: Eur Stroke J Date: 2018-02-01