Stroke: Golden Hour Thrombolysis Improved Discharge To Home

MedicalResearch.com Interview with:
Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger
Center for Stroke Research Berlin (CSB)
Charité – Universitätsmedizin Berlin | CCM
Berlin | Germany

Medical Research: What is the background for this study? What are the main findings?

Response:
Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That’s because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial – both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities.

Medical Research: What should clinicians and patients take away from your report?

Response: Our report again emphasizes the importance of speedy delivery of thrombolysis in ischemic stroke. Jeff Saver from UCLA recently published US data on the impact every 15 minute delay has on clinical outcomes. Chances for a patient to leave the hospital walking drop by 4%. Or, as Atte Mertoja, Melbourne, Australia, puts it nicely in one of his recent publications: ‘Save a minute, save a day’. The STEMO turned out to be an excellent tool to increase the number of golden hour thrombolysis by the factor 10, allowing for the first time to analyze clinical effects of very early thrombolysis.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: So far, data from STEMO have been very convincing. They demonstrated a clear benefit in terms of time reduction from alarm to treatment. Given the most obvious association between time to treatment and functional outcome measured with the gold standard, i.e. modified Rankin Scale after 3 months, one would assume that thrombolysis in STEMO should be more effective than in-hospital thrombolysis. However, we are still lacking a study that has the power to show this over the entire 4.5 hour time window.

Citation:

Ebinger M, Kunz A, Wendt M, et al. Effects of Golden Hour Thrombolysis: A Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) Substudy. JAMA Neurol. Published online November 17, 2014. doi:10.1001/jamaneurol.2014.3188.

 

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