“Five minutes separate a spastic palsy from an acceptable recovery.”
The warning from the Neurology instructor, who was discussing the timely use of thrombolysis agents in his ward rounds, got seared in my memory.
Fully equipped mobile units are being used in Berlin, Germany, to make an early evaluation of Stroke and determine whether they can benefit from the use of anticoagulants. There are two types of Stroke: ischemic, i.e. without blood, and hemorrhagic, i.e. with blood that precludes the use of that medication.
Those systems use an ambulance equipped with a computed tomography (CT), a laboratory testing unit and the evaluation of keen medical personnel, including a neurologist. A study of 2027 patients treated by those mobile units showed that 614 (30,3%) were diagnosed with ischemic stroke.
A prospective observational study was conducted between July 18 and November 1, 2014, in the Cleveland Clinic after it implemented a Mobile Stroke Treatment Unit (MSTU). The only difference with the German units was that the first 100 patients were evaluated by a vascular neurologist via Telemedicine and the CT images were assessed online by a neuroradiologist.
The MSTU were significantly faster in the diagnosis and treatment of Stroke patients compared to the traditional method of Emergency Medical Systems transport to an Emergency Room. The time span from “the door to CT completion” was on average 13 minutes with them and 18 minutes in the control group. The time span between “the door to intravenous thrombolyis” was on average 32 minutes compared to 58 minutes in the control group.
The intravenous thrombolysis was successfully administered in 16 patients out of a positive diagnosis of Stroke in 33 cases. The shortest time from the door to intravenous tPA administration was 11 minutes. The researchers are confident that these numbers herald the dawn of a promising era in Stroke medicine. The patients and their families surely agree with their optimism.
What do you think? Please tell us.
Don’t leave me alone.