Bringing the hospital to the patient: first treatment of stroke patients at the emergency site.
BACKGROUND
Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.


RESULTS
We developed a "Mobile Stroke Unit", consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital. In a departure from current practice, stroke patients could be differentially treated according to their ischemic or hemorrhagic etiology even in the prehospital phase of stroke management. Immediate diagnosis of cerebral ischemia and exclusion of thrombolysis contraindications enabled us to perform prehospital rt-PA thrombolysis as bridging to later intra-arterial recanalization in one patient. In a complementary patient with cerebral hemorrhage, prehospital diagnosis allowed immediate initiation of hemorrhage-specific blood pressure management and telemedicine consultation regarding surgery. Call-to-therapy-decision times were 35 minutes.


CONCLUSIONS
This preliminary study proves the feasibility of guideline-adherent, etiology-specific and causal treatment of acute stroke directly at the emergency site.
Department of Neurology, University Hospital of the Saarland, Homburg, Germany.
Silke
S
Walter
Panagiotis
P
Kostpopoulos
Anton
A
Haass
Stefan
S
Helwig
Isabel
I
Keller
Tamara
T
Licina
Thomas
T
Schlechtriemen
Christian
C
Roth
Panagiotis
P
Papanagiotou
Anna
A
Zimmer
Julio
J
Viera
Julio
J
Vierra
Heiko
H
Körner
Kathrin
K
Schmidt
Marie-Sophie
MS
Romann
Maria
M
Alexandrou
Umut
U
Yilmaz
Iris
I
Grunwald
Darius
D
Kubulus
Martin
M
Lesmeister
Stephan
S
Ziegeler
Alexander
A
Pattar
Martin
M
Golinski
Yang
Y
Liu
Thomas
T
Volk
Thomas
T
Bertsch
Wolfgang
W
Reith
Klaus
K
Fassbender
D004638:Emergency Treatment; D006801:Humans; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed