When a clot blocks a blood vessel in the brain, as happens in strokes, every minute counts. The Stroke Emergency Mobile (STEMO) of the Berlin STEMO Consortium of the Fire Department and the Charité offers a possibility to start the saving stroke treatment already during the drive to the hospital. Now, a JAMA study has confirmed that the therapy is safe and shortens the time it takes to start therapy by an average of 25 minutes. According to experts, however, evidence of improved quality of outcomes is also necessary. With the significant costs involved, a positive cost-benefit ratio would have to be provided.
(ag) Lysis therapy can be administered to a stroke patient within up to 4.5 hours after the onset of the event, and the earlier it begins, the more successful it is.
The slogan “time is brain” is widespread: An estimated two million brain cells die every minute during a stroke. Since many people recognize symptoms of stroke late, the STEMO project is now intended to ensure that therapy can already be started in the ambulance and to gain valuable time for the patient. The ambulance is equipped with a built-in CT scan and laboratory, as well as a neurologist, paramedic and X-ray MTA on board. CT allows the exclusion of a cerebral hemorrhage as the cause of the stroke and lysis therapy can begin directly on site. In addition, the STEMO vehicle has a telemedical network, via which the emergency physician exchanges information with specialists in the hospital.
How does the project prove itself in practice?
STEMO has been in operation since May 2011. Until the end of January 2013, it was used every two weeks. During this time, we conducted a study to investigate the advantages of early stroke-specific treatment in STEMO compared with conventional care (performed in each of the other weeks). Now the results have been presented: Patients in the STEMO vehicle began lysis an average of 52 minutes after the alarm, 25 minutes earlier than the control group. The proportion of stroke patients who underwent lysis also increased: from 21 to 33%. However, the researchers were unable to verify in the study whether this actually left more patients without disabilities. The study population was too small for this. Moreover, for data protection reasons, the treatment result was not available from all patients after three months.
Since it is not known how strong the effect on the final results is and whether the (very expensive) effort is worthwhile, experts are cautious, but are in favor of further studies in this area.
Source: Media release from May 20, 2014
CARDIOVASC 2014; 13(3): 26
