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. 2010 Oct 29;5(10):e13758.
doi: 10.1371/journal.pone.0013758.

Bringing the hospital to the patient: first treatment of stroke patients at the emergency site

Silke Walter  1 , Panagiotis Kostpopoulos, Anton Haass, Stefan Helwig, Isabel Keller, Tamara Licina, Thomas Schlechtriemen, Christian Roth, Panagiotis Papanagiotou, Anna Zimmer, Julio Viera, Heiko Körner, Kathrin Schmidt, Marie-Sophie Romann, Maria Alexandrou, Umut Yilmaz, Iris Grunwald, Darius Kubulus, Martin Lesmeister, Stephan Ziegeler, Alexander Pattar, Martin Golinski, Yang Liu, Thomas Volk, Thomas Bertsch, Wolfgang Reith, Klaus Fassbender
Affiliations

Bringing the hospital to the patient: first treatment of stroke patients at the emergency site

Silke Walter et al. PLoS One. .

Erratum in

Abstract

Background: Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.

Methods and findings: We developed a "Mobile Stroke Unit", consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital. In a departure from current practice, stroke patients could be differentially treated according to their ischemic or hemorrhagic etiology even in the prehospital phase of stroke management. Immediate diagnosis of cerebral ischemia and exclusion of thrombolysis contraindications enabled us to perform prehospital rt-PA thrombolysis as bridging to later intra-arterial recanalization in one patient. In a complementary patient with cerebral hemorrhage, prehospital diagnosis allowed immediate initiation of hemorrhage-specific blood pressure management and telemedicine consultation regarding surgery. Call-to-therapy-decision times were 35 minutes.

Conclusion: This preliminary study proves the feasibility of guideline-adherent, etiology-specific and causal treatment of acute stroke directly at the emergency site.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Brain imaging in prehospitally treated stroke patients
. Patient with ischemic stroke: Prehospital CT excluded contraindications for thrombolysis as a precondition for prehospital rt-PA thrombolysis (A). The “hyperdense middle cerebral artery” sign (arrow) suggested middle cerebral artery occlusion that was later confirmed in hospital by angiography (B), and reopened by intraarterial recanaliziation (C). Diffusion-weighted magnetic resonance imaging at day 7 showed the residual infarction (D). Patient with hemorrhagic stroke: Prehospital CT scan allowed immediate diagnosis of intracerebral hemorrhage with ventricular extension (E), as a precondition for prehospital differential blood pressure management and telemedicine consultation with hospital experts. CT performed at day 24 shows the residual lesion (F).
Figure 2
Figure 2. Mobile Stroke Unit.
An ambulance (A) equipped with point-of care laboratory system and telemedicine devices (B) and CT (C) required for prehospital stroke treatment.
See this image and copyright information in PMC

Comment in

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