A Mobile Stroke Treatment Unit for Field Triage of Patients for Intraarterial Revascularization Therapy

被引：63

作者：

Cerejo, Russell ^{[1
]}

John, Seby ^{[1
]}

Buletko, Andrew B. ^{[2
]}

Taqui, Ather ^{[1
]}

Itrat, Ahmed ^{[1
]}

Organek, Natalie ^{[2
]}

Cho, Sung-Min ^{[2
]}

Sheikhi, Lila ^{[2
]}

Uchino, Ken ^{[1
]}

Briggs, Farren ^{[3
]}

Reimer, Andrew P. ^{[4
,5
]}

Winners, Stacey ^{[1
]}

Toth, Gabor ^{[1
]}

Rasmussen, Peter ^{[1
]}

Hussain, Muhammad S. ^{[1
]}

机构：

[1] Cleveland Clin, Cerebrovasc Ctr, Cleveland, OH 44106 USA

[2] Cleveland Clin, Dept Neurol, Cleveland, OH 44106 USA

[3] Case Western Reserve Univ, Dept Epidemiol & Biostat, Sch Med, Cleveland, OH 44106 USA

[4] Cleveland Clin, Crit Care Transport Team, Cleveland, OH 44106 USA

[5] Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH 44106 USA

来源：

JOURNAL OF NEUROIMAGING | 2015年 / 25卷 / 06期

关键词：

Mobile Stroke Treatment Unit (MSTU); prehospital emergency care; stroke; thrombectomy; ACUTE ISCHEMIC-STROKE; RANDOMIZED CONTROLLED-TRIAL; INTRAVENOUS T-PA; ENDOVASCULAR THERAPY; THROMBOLYSIS; THROMBECTOMY; ONSET; TIME; ASSOCIATION; REPERFUSION;

D O I：

10.1111/jon.12276

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

INTRODUCTIONFavorable outcomes in intraarterial therapy (IAT) for acute ischemic stroke (AIS) are related to early vessel recanalization. The mobile stroke treatment unit (MSTU) is an on-site, prehospital, treatment team, laboratory, and CT scanner that reduces time to treatment for intravenous thrombolysis and may also shorten time to IAT. METHODSUsing our MSTU database, we identified patients that underwent IAT for AIS. We compared the key time metrics to historical controls, which included patients that underwent IAT at our institution six months prior to implementation of the MSTU. We further divided the controls into two groups: (1) transferred to our institution for IAT and (2) directly presented to our emergency room and underwent IAT. RESULTSAfter 164 days of service, the MSTU transported 155 patients of which 5 underwent IAT. We identified 5 historical controls that were transferred to our center for IAT. Substantial reduction in times including median door to initial CT (12minute vs. 32minute), CT to IAT (82minute vs. 165minute), and door to MSTU/primary stroke center departure (37minute vs. 106minute) were noted among the two groups. Compared to the 6 patients who presented to our institution directly, the MSTU process times were also shorter. CONCLUSIONOur initial experience shows that MSTU may help in early triage and shorten the time to IAT for AIS.

引用

页码：940 / 945

页数：6

共 30 条

[1] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[2] Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke [J].

Broderick, Joseph P. ;

Palesch, Yuko Y. ;

Demchuk, Andrew M. ;

Yeatts, Sharon D. ;

Khatri, Pooja ;

Hill, Michael D. ;

Jauch, Edward C. ;

Jovin, Tudor G. ;

Yan, Bernard ;

Silver, Frank L. ;

von Kummer, Ruediger ;

Molina, Carlos A. ;

Demaerschalk, Bart M. ;

Budzik, Ronald ;

Clark, Wayne M. ;

Zaidat, Osama O. ;

Malisch, Tim W. ;

Goyal, Mayank ;

Schonewille, Wouter J. ;

Mazighi, Mikael ;

Engelter, Stefan T. ;

Anderson, Craig ;

Spilker, Judith ;

Carrozzella, Janice ;

Ryckborst, Karla J. ;

Janis, L. Scott ;

Martin, Renee H. ;

Foster, Lydia D. ;

Tomsick, Thomas A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (10) :893-903

[3] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[4] The Benefits of Intravenous Thrombolysis Relate to the Site of Baseline Arterial Occlusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) [J].

De Silva, Deidre A. ;

Brekenfeld, Caspar ;

Ebinger, Martin ;

Christensen, Soren ;

Barber, P. Alan ;

Butcher, Kenneth S. ;

Levi, Christopher R. ;

Parsons, Mark W. ;

Bladin, Christopher F. ;

Donnan, Geoffrey A. ;

Davis, Stephen M. .

STROKE, 2010, 41 (02) :295-299

[5] Effect of the Use of Ambulance-Based Thrombolysis on Time to Thrombolysis in Acute Ischemic Stroke A Randomized Clinical Trial [J].

Ebinger, Martin ;

Winter, Benjamin ;

Wendt, Matthias ;

Weber, Joachim E. ;

Waldschmidt, Carolin ;

Rozanski, Michal ;

Kunz, Alexander ;

Koch, Peter ;

Kellner, Philipp A. ;

Gierhake, Daniel ;

Villringer, Kersten ;

Fiebach, Jochen B. ;

Grittner, Ulrike ;

Hartmann, Andreas ;

Mackert, Bruno-Marcel ;

Endres, Matthias ;

Audebert, Heinrich J. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 311 (16) :1622-1631

[6] Mobile stroke unit for hyperacute stroke treatment [J].

Fassbender, K ;

Walter, S ;

Liu, Y ;

Muehlhauser, F ;

Ragoschke, A ;

Kuehl, S ;

Mielke, O .

STROKE, 2003, 34 (06) :E44-E44

[7] The Impact of a Statewide Pre-Hospital STEMI Strategy to Bypass Hospitals Without Percutaneous Coronary Intervention Capability on Treatment Times [J].

Fosbol, Emil L. ;

Granger, Christopher B. ;

Jollis, James G. ;

Monk, Lisa ;

Lin, Li ;

Lytle, Barbara L. ;

Xian, Ying ;

Garvey, J. Lee ;

Mears, Greg ;

Corbett, Claire C. ;

Peterson, Eric D. ;

Glickman, Seth W. .

CIRCULATION, 2013, 127 (05) :604-612

[8] Intra-arterial prourokinase for acute ischemic stroke - The PROACT II study: A randomized controlled trial [J].

Furlan, A ;

Higashida, R ;

Wechsler, L ;

Gent, M ;

Rowley, H ;

Kase, C ;

Pessin, M ;

Ahuja, A ;

Callahan, F ;

Clark, WM ;

Silver, F ;

Rivera, F .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (21) :2003-2011

[9] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[10] Evaluation of Interval Times From Onset to Reperfusion in Patients Undergoing Endovascular Therapy in the Interventional Management of Stroke III Trial [J].

Goyal, Mayank ;

Almekhlafi, Mohammed A. ;

Fan, Liqiong ;

Menon, Bijoy K. ;

Demchuk, Andrew M. ;

Yeatts, Sharon D. ;

Hill, Michael D. ;

Tomsick, Thomas ;

Khatri, Pooja ;

Zaidat, Osama O. ;

Jauch, Edward C. ;

Eesa, Muneer ;

Jovin, Tudor G. ;

Broderick, Joseph P. .

CIRCULATION, 2014, 130 (03) :265-U120

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