The overall goal of pre-hospital thrombolysis is to improve the outcome of acute ischemic stroke patients. The effects of thrombolysis are time dependent. Every 15 minutes lost results in fewer patients being successfully treated to reduce the delays between symptom onset and thrombolysis.
A previously developed and validated algorithm is used by a dispatch center. A pre-hospital stroke team is trained and a specialized ambulance. The demo is equipped with a computed tomography, scanner, and point-of-care laboratory.
Ultimately, this pre-hospital concept results in faster and more frequent thrombolysis of acute ischemic stroke patients without increased risks. The main advantage of pre-hospital thrombolysis compared to routine thrombolysis in hospitals is that this time dependent treatment can be delivered earlier. This video shows the simulation of a stroke emergency responded to by a real pre-hospital stroke team.
Using the STEAM O, a specialized ambulance equipped with a CT scanner and a point of care laboratory. An incoming medical emergency call presents as a stroke emergency. The dispatcher answers the call using daes and radios, the alarm to demo.
The demo emergency response team receives the alert immediately grabs the facts, containing the detailed information and rushes to the demo vehicle after the critical status of the patient is assessed. Explore the patient's medical history. If a stroke is suspected clinically, assess the severity of the symptoms using the NIH stroke Scale.
Determine the exact onset of symptoms and ask for current medication with a focus on anticoagulation therapy. At the same time, measure and log the patient's vital signs such as heart rate, blood pressure, blood sugar concentration, and oxygen saturation. Next, after disinfection place a peripheral venous catheter and take some blood samples.
Now, determine the international normalized ratio. Apply the blood sample to the target area of the test strip in a few seconds. The ratio will display when interventions and advanced diagnostics are required.
Immediately transfer the patient to the STEM via a stretcher and contact the on-call neuroradiologist to discuss the indication for CT scanning. To rule out in intercerebral bleeds, a CT scan is required when stroke is suspected. Thrombolysis is contraindicated in case of hemorrhagic stroke, and in case CT reveals other conditions associated with increased bleeding.
In this demo, insert the vacutainer tubes into the lab and measure the standard set of blood parameters. Position the patients on the stretcher for CT scanning. Then start the CT scan.
Taking the appropriate precautions, the radiology technician must be shielded and the other staff must leave the vehicle. The CT images are then transferred to the neuroradiologist on call, who will send back a written report after the CT scan. Ask the patient for contraindications against thrombolytic therapy using a standardized checklist.
If neither this checklist nor the CT scan, reveal contraindications. Explain the benefits and possible risks of thrombolysis and obtained informed consent if possible. If in doubt, further expert opinion from an outside expert may be requested using onboard telemedicine equipment.
First, calculate the dose of Alta Place based on the patient's estimated body weight. Next, prepare the Alta place for injection. Initiate the thrombolysis by administering 10%of the calculated total dose as a bolus injection over one minute.
Record this time point, and be prepared to administer antiallergic drugs in case they are needed. Evacuate the air from an injection pump syringe and tubing and proceed with injecting the remaining dose of Alta Place. Over 60 minutes now, prepare your summary for handover at hospital arrival.
Notify the ER of the closest hospital with a certified stroke unit of your impending arrival and while in transit, monitor the patient's neurological deficits and vital signs. En route. Print out and sign the admission letter containing the diagnosis.
Patient history, neurological exam on-call, neuroradiologist report, lab results, and a description of actions taken. Also, copy the CT scan data to a CD for the hospital. During a three month pilot study in 2011, informed consent was given by 77 subjects treated in this demo.
45 of these patients had an acute ischemic stroke and 23 received TPA. The meantime from emergency call to TPA administration was 36 minutes faster than that of a control cohort of 50 patients within hospital thrombolysis in Berlin during 2010. The pre-hospital thrombolysis concept assures that TPA can be given as soon as possible if the same precautions are taken as in the routine hospital thrombolysis, there's no additional risks with TPA delivered in sti.
We may be able to treat many more patients within the so-called golden hour, yielding the highest treatment effects.
