PHANTOM-S: the prehospital acute neurological therapy and optimization of medical care in stroke patients - study.
BACKGROUND
Time from symptom onset to treatment is closely associated with the effectiveness of intravenous thrombolysis in acute ischemic stroke patients. Hospitals are encouraged to take every effort to shorten delay of treatment. Despite combined efforts to streamline procedures in hospitals to provide treatment as soon as possible, most patients receive tissue plasminogen activator with considerable delay and very few of them within 90 mins. Germany has an internationally acknowledged prehospital emergency care system with specially trained doctors on ambulances. We developed an ambulance equipped with a Computed Tomography (CT) scanner, point-of-care laboratory, teleradiological support, and an emergency-trained neurologist on board. In the Pre-Hospital Acute Neurological Therapy and Optimization of Medical care in Stroke Patients study, we aim at a reduction of the current alarm-to-needle time by prehospital use of tissue plasminogen activator in an ambulance.


OBJECTIVE
We hypothesized that compared with regular care, we will reduce alarm-to-needle time by a minimum of 20 mins by implementation of the stroke emergency mobile unit.


METHODS
Prospective study comparing randomly allocated periods with and without stroke emergency mobile unit availability.


RESULTS
Primary end point of the study is alarm-to-needle time. Secondary outcomes include thrombolysis treatment rates, modified Rankin scale after three-months, and alarm-to-imaging or alarm-to-laboratory time; safety aspects to be evaluated are mortality and rates of (symptomatic) intracerebral hemorrhage.
Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany. martin.ebinger@charite.de
Martin
M
Ebinger
Michal
M
Rozanski
Carolin
C
Waldschmidt
Joachim
J
Weber
Matthias
M
Wendt
Benjamin
B
Winter
Philipp
P
Kellner
André-Michael
AM
Baumann
Uwe
U
Malzahn
Peter U
PU
Heuschmann
Jochen B
JB
Fiebach
Matthias
M
Endres
Heinrich J
HJ
Audebert
D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D001604:Berlin; D004632:Emergency Medical Services / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator