Abstract 104: Golden Hour-Thrombolysis by Starting Treatment Before Hospital Arrival the Pre-Hospital Acute Neurological Treatment and Optimization of Medical Care in Stroke Study (PHANTOM-S)
Objective: The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if onset-to-treatment time (OTT) is < 60 minutes, the so called Golden-Hour. Starting thrombolysis in a specialized ambulance with a CT-scanner plus point-of-care laboratory reduced time from emergency call to treatment in the prospective controlled PHANTOM-S study. We evaluated the rate and effectiveness of Golden-Hour thrombolysis.
Methods: The stroke emergency mobile (STEMO) is staffed with a neurologist trained in emergency medicine, a paramedic and a technician. The effects of the STEMO implementation were evaluated in a prospective study comparing weeks with and without STEMO-availability. STEMO was deployed when the dispatchers suspected an acute stroke during emergency calls. If STEMO was not available (in operation or maintenance), patients received conventional care. OTT-intervals were dichotomized in either ≤60 (Golden-Hour) or > 60 minutes as well as categorized in 10-minute intervals from 0 to 270 minutes for graphical description.
Results: Overall, thrombolysis rates in ischemic stroke were 33% (200/614) when STEMO was deployed and 22% (330/1497) in conventional care (p<0.001). The proportion of Golden-Hour treatments (from all thrombolysis) was 6-fold higher after STEMO deployment (31.0%; n= 62 versus 4.9%; n=16; p<0.01). Compared to patients with longer OTT patients with Golden-Hour thrombolysis had no higher risks for 7- or 90-day mortality (adjusted ORs: 0.38, 95%-CI: 0.09-1.70 and 0.69, 95%-CI: 0.32-1.53) but were more likely to be discharged at home (adjusted OR: 1.93 95%CI: 1.09-3.41; p=0.024).
Conclusion: STEMO increased the percentage of patients treated within the Golden-Hour. This entailed no risk to patients’ safety and was associated with better short-term outcome.
Author Disclosures: M. Ebinger: None. M. Wendt: None. M. Rozanski: None. B. Winter: None. C. Waldschmidt: None. J. Weber: None. K. Villringer: None. J. Fiebach: Honoraria; Modest; MEYTEC. A. Kunz: None. H.J. Audebert: Honoraria; Modest; Boehringer Ingelheim. Consultant/Advisory Board; Modest; Lundbeck. Honoraria; Significant; No. Consultant/Advisory Board; Significant; Yes.
- © 2014 by American Heart Association, Inc.