'Golden Hour' Thrombolysis Improves with Mobile Stroke Units

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An ambulance specifically equipped to treat strokes helped increase the percentage of patients with stroke who received thrombolysis within the 60-minute time frame where treatment is most effective, according to a study published in JAMA Neurology.

Lead researcher Martin Ebinger, MD, of the Charité-Universitätsmedizin, and colleagues found that ambulances staffed with a neurologist and equipped with a computed tomographic scanner helped more patients with stroke receive treatment with tissue plasminogen activator (tPA) to break down blood clots within the so-called “golden hour” after symptom onset.

The researchers used data from a study conducted in Berlin where weeks were randomized according to the availability of a stroke emergency mobile unit (STEMO) from May 2011 through January 2013.

There were 3,213 emergency calls for suspected stroke during weeks when STEMO was available and 2,969 calls during control weeks when STEMO was not available. When the STEMO was deployed, 32.6% of patients with stroke received thrombolysis compared with 22% who received it during control weeks. Median onset to treatment was 24.5 minutes shorter with STEMO than with traditional care. In all ischemic strokes, the rate of golden hour treatment increased from 1.1% with conventional care to 10.1% with STEMO deployment.

In a related editorial, Steven Warach, MD, PhD, of the University of Texas Southwestern Medical Center, which has been testing its own mobile stroke unit, wrote, “Many questions need to be answered in order to determine the appropriate niche where the benefit justifies the intensive use of resources that this approach requires. It is the duty of the early adopters to resist the temptation to uncritically embrace this approach as a certain good and to address these issues through rigorous clinical investigations.”

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Golden Hour Thrombolysis and the Benefits of Mobile Stroke Units

The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the importance golden hour. 

The prospective controlled Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke study was conducted in Berlin, Germany, within an established infrastructure for stroke care. Weeks were randomized according to the availability of a specialized ambulance (stroke emergency mobile unit (STEMO) from May 1, 2011, through January 31, 2013.

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