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Abstract
Brain cells die rapidly after stroke and any effective treatment must start as early as possible. In clinical routine, the tight time–outcome relationship continues to be the major limitation of therapeutic approaches: thrombolysis rates remain low across many countries, with most patients being treated at the late end of the therapeutic window. In addition, there is no neuroprotective therapy available, but some maintain that this concept may be valid if administered very early after stroke. Recent innovations have opened new perspectives for stroke diagnosis and treatment before the patient arrives at the hospital. These include stroke recognition by dispatchers and paramedics, mobile telemedicine for remote clinical examination and imaging, and integration of CT scanners and point-of-care laboratories in ambulances. Several clinical trials are now being performed in the prehospital setting testing prehospital delivery of neuroprotective, antihypertensive, and thrombolytic therapy. We hypothesize that these new approaches in prehospital stroke care will not only shorten time to treatment and improve outcome but will also facilitate hyperacute stroke research by increasing the number of study participants within an ultra-early time window. The potentials, pitfalls, and promises of advanced prehospital stroke care and research are discussed in this review.
GLOSSARY
- DIASE=
- Dispatcher Identification Algorithm for Stroke Emergencies;
- EMS=
- Emergency Medical System;
- GWTG-Stroke=
- Get With the Guidelines Stroke;
- PIL-FAST=
- Paramedic-Initiated Lisinopril For Acute Stroke Treatment;
- FAST-MAG=
- Field Administration of Stroke Therapy–Magnesium;
- IMAGES=
- Intravenous Magnesium Efficacy in Acute Stroke;
- SITS-MOST=
- Safe Implementation of Thrombolysis in Stroke–Monitoring Study;
- STEMO=
- Stroke Emergency Mobile;
- tPA=
- tissue plasminogen activator
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received February 14, 2013.
- Accepted in final form May 16, 2013.
- © 2013 American Academy of Neurology
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- Abstract
- GLOSSARY
- THE “TIME IS BRAIN” RATIONALE OF ACUTE STROKE CARE
- DELAYS IN TIME TO TREATMENT—ALL LINKS OF THE RESCUE CHAIN ARE IMPORTANT
- CURRENT APPROACHES TO ADVANCING PREHOSPITAL STROKE MANAGEMENT
- LIMITATIONS AND PITFALLS
- PREHOSPITAL STROKE DIAGNOSIS AND TREATMENT: THE PROMISE OF FASTER AND BETTER TREATMENT NOT LIMITED TO IV tPA
- PREHOSPITAL STROKE MANAGEMENT OPENS THE DOOR TO TREATMENT TRIALS IN THE GOLDEN HOUR
- OUTLOOK
- AUTHOR CONTRIBUTIONS
- STUDY FUNDING
- DISCLOSURE
- Footnotes
- REFERENCES
- Figures & Data
- Info & Disclosures
