Stroke: prospective evaluation of a prehospital management process based on rescuers
Improving access to thrombolytic therapy for patients with ischemic stroke is challenging. We assessed a prehospital process based on firemen rescuers under strict medical direction, aimed at facilitating thrombolysis of eligible patients.
This was a prospective observational study conducted over 4 months in Paris, France. Prehospital patients with suspected stroke were included after phone consultation with a physician. If the time since the onset of symptoms was less than 6 hours, patients were transported directly to a neurovascular unit (NVU), if symptom onset was over 6 hours ago; they were transported to an emergency department. Confirmation of stroke diagnosis, the rate of thrombolysis, and the time intervals between the call and hospital arrival and imaging were assessed. Comparison used Fisher’s exact test.
Of the 271 patients transported to an NVU, 218 were diagnosed with a stroke (166 with ischemic stroke), 69 received thrombolytic therapy, and the mean stroke-thrombolysis interval was 150 minutes. Over 64 patients admitted to ED, 36 patients suffered a stroke (ischaemic: 24). None were thrombolysed. Globally, 36% of ischaemic strokes were thrombolysed (27% of all strokes diagnosed). The mean interval call-hospital was 65 min (ED vs NVU: p=0.61). The interval call-imaging was 202 min [IQR: 105.5-254.5] for ED and 92 min [IQR: 77 116] for NVU (p<0.001).
The prehospital management of stroke by rescuers, under strict medical direction, seemed to be feasible and effective for selection of patients suffering from stroke in an urban environment, and may improve the access to thrombolysis.