title: Prehospital thrombolysis: a manual from Berlin.
abstract: In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient's medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse). Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.
authors.affiliation: Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin.
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.forename: Sascha
authors.initials: S
authors.lastname: Lindenlaub
authors.forename: Alexander
authors.initials: A
authors.lastname: Kunz
authors.forename: Michal
authors.initials: M
authors.lastname: Rozanski
authors.forename: Carolin
authors.initials: C
authors.lastname: Waldschmidt
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Weber
authors.forename: Matthias
authors.initials: M
authors.lastname: Wendt
authors.forename: Benjamin
authors.initials: B
authors.lastname: Winter
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kellner
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: D004632:Emergency Medical Services / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods*; D006801:Humans; D019095:Point-of-Care Systems; D011994:Recombinant Proteins / Q000008:administration & dosage; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator