title: Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study.
abstract: OBJECTIVE
  Beneficial effects of IV tissue plasminogen activator (tPA) in acute ischemic stroke are strongly time-dependent. In the Pre-Hospital Acute Neurological Treatment and Optimization of Medical care in Stroke (PHANTOM-S) study, we undertook stroke treatment using a specialized ambulance, the stroke emergency mobile unit (STEMO), to shorten call-to-treatment time.
  
  
  METHODS
  The ambulance was staffed with a neurologist, paramedic, and radiographer and equipped with a CT scanner, point-of-care laboratory, and a teleradiology system. It was deployed by the dispatch center whenever a specific emergency call algorithm indicated an acute stroke situation. Study-specific procedures were restricted to patients able to give informed consent. We report feasibility, safety, and duration of procedures regarding prehospital tPA administration.
  
  
  RESULTS
  From February 8 to April 30, 2011, 152 subjects were treated in STEMO. Informed consent was given by 77 patients. Forty-five (58%) had an acute ischemic stroke and 23 (51%) of these patients received tPA. The mean call-to-needle time was 62 minutes compared with 98 minutes in 50 consecutive patients treated in 2010. Two (9%) of the tPA-treated patients had a symptomatic intracranial hemorrhage and 1 of these patients (4%) died in hospital. Technical failures encountered were 1 CT dysfunction and 2 delayed CT image transmissions.
  
  
  CONCLUSIONS
  The data suggest that prehospital stroke care in STEMO is feasible. No safety concerns have been raised so far. This new approach using prehospital tPA may be effective in reducing call-to-needle times, but this is currently being scrutinized in a prospective controlled study.
authors.affiliation: Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Weber
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.forename: Michal
authors.initials: M
authors.lastname: Rozanski
authors.forename: Carolin
authors.initials: C
authors.lastname: Waldschmidt
authors.forename: Matthias
authors.initials: M
authors.lastname: Wendt
authors.forename: Benjamin
authors.initials: B
authors.lastname: Winter
authors.forename: Philipp
authors.initials: P
authors.lastname: Kellner
authors.forename: André
authors.initials: A
authors.lastname: Baumann
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.forename: Kersten
authors.initials: K
authors.lastname: Villringer
authors.forename: Sabina
authors.initials: S
authors.lastname: Kaczmarek
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000552:Ambulances; D004282:Documentation; D004632:Emergency Medical Services / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010865:Pilot Projects; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D010959:Tissue Plasminogen Activator