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Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy

BACKGROUND: The number of mobile stroke programmes has increased with evidence, showing they expedite intravenous thrombolysis. Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes. OBJECTIVE: Our mobile stroke unit (MSU...

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Autores principales: Bender, Matthew T, Mattingly, Thomas K, Rahmani, Redi, Proper, Diana, Burnett, Walter A, Burgett, Jason L, LEsperance, Joshua, Cushman, Jeremy T, Pilcher, Webster H, Benesch, Curtis G, Kelly, Adam G, Bhalla, Tarun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240459/
https://www.ncbi.nlm.nih.gov/pubmed/34952889
http://dx.doi.org/10.1136/svn-2021-001119
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author Bender, Matthew T
Mattingly, Thomas K
Rahmani, Redi
Proper, Diana
Burnett, Walter A
Burgett, Jason L
LEsperance, Joshua
Cushman, Jeremy T
Pilcher, Webster H
Benesch, Curtis G
Kelly, Adam G
Bhalla, Tarun
author_facet Bender, Matthew T
Mattingly, Thomas K
Rahmani, Redi
Proper, Diana
Burnett, Walter A
Burgett, Jason L
LEsperance, Joshua
Cushman, Jeremy T
Pilcher, Webster H
Benesch, Curtis G
Kelly, Adam G
Bhalla, Tarun
author_sort Bender, Matthew T
collection PubMed
description BACKGROUND: The number of mobile stroke programmes has increased with evidence, showing they expedite intravenous thrombolysis. Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes. OBJECTIVE: Our mobile stroke unit (MSU), based at an academic medical centre in upstate New York, launched in October 2018. We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service (EMS) patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes. RESULTS: Over 568 days in service, the MSU was dispatched 1489 times (2.6/day) and transported 300 patients (20% of dispatches). Intravenous tissue plasminogen activator (tPA) was administered to 57 MSU patients and the average time from 911 call-to-tPA was 42.5 min (±9.2), while EMS transported 73 patients who received tPA at 99.4 min (±35.7) (p<0.001). Seven MSU patients (12%) received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care. Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to-groin puncture time of 99.9 min (±18.1), while EMS transported 54 patients who underwent endovascular thrombectomy (ET) at 133.0 min (±37.0) (p=0.0002). There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy, whether assessed as a dichotomous or ordinal variable. CONCLUSIONS: Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy. There is an ongoing need to show improved functional outcomes with MSU care.
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spelling pubmed-92404592022-07-20 Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy Bender, Matthew T Mattingly, Thomas K Rahmani, Redi Proper, Diana Burnett, Walter A Burgett, Jason L LEsperance, Joshua Cushman, Jeremy T Pilcher, Webster H Benesch, Curtis G Kelly, Adam G Bhalla, Tarun Stroke Vasc Neurol Original Research BACKGROUND: The number of mobile stroke programmes has increased with evidence, showing they expedite intravenous thrombolysis. Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes. OBJECTIVE: Our mobile stroke unit (MSU), based at an academic medical centre in upstate New York, launched in October 2018. We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service (EMS) patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes. RESULTS: Over 568 days in service, the MSU was dispatched 1489 times (2.6/day) and transported 300 patients (20% of dispatches). Intravenous tissue plasminogen activator (tPA) was administered to 57 MSU patients and the average time from 911 call-to-tPA was 42.5 min (±9.2), while EMS transported 73 patients who received tPA at 99.4 min (±35.7) (p<0.001). Seven MSU patients (12%) received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care. Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to-groin puncture time of 99.9 min (±18.1), while EMS transported 54 patients who underwent endovascular thrombectomy (ET) at 133.0 min (±37.0) (p=0.0002). There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy, whether assessed as a dichotomous or ordinal variable. CONCLUSIONS: Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy. There is an ongoing need to show improved functional outcomes with MSU care. BMJ Publishing Group 2021-12-24 /pmc/articles/PMC9240459/ /pubmed/34952889 http://dx.doi.org/10.1136/svn-2021-001119 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Bender, Matthew T
Mattingly, Thomas K
Rahmani, Redi
Proper, Diana
Burnett, Walter A
Burgett, Jason L
LEsperance, Joshua
Cushman, Jeremy T
Pilcher, Webster H
Benesch, Curtis G
Kelly, Adam G
Bhalla, Tarun
Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
title Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
title_full Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
title_fullStr Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
title_full_unstemmed Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
title_short Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
title_sort mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240459/
https://www.ncbi.nlm.nih.gov/pubmed/34952889
http://dx.doi.org/10.1136/svn-2021-001119
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