Date Published: June 1, 2018
Publisher: JKL International LLC
Author(s): Sheng Zhang, Jungen Zhang, Meixia Zhang, Genlong Zhong, Zhicai Chen, Longting Lin, Min Lou.
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) can improve clinical outcome in eligible patients with acute ischemic stroke (AIS). However, its efficacy is strongly time-dependent. This study was aimed to examine whether prehospital notification by emergency medical service (EMS) providers could reduce onset to needle time (ONT) and improve neurological outcome in AIS patients who received IVT. We prospectively collected the consecutive clinical and time data of AIS patients who received IVT during one year after the initiation of prehospital notification procedure (PNP). Patients were divided into three groups, including patients that transferred by EMS with and without PNP and other means of transportation (non-EMS). We then compared the effect of EMS with PNP and EMS use only on ONT, and the subsequent neurological outcome. Good outcome was defined as modified Rankin Scale score of 0-2 at 3-months. In 182 patients included in this study, 77 (42.3%) patients were transferred by EMS, of whom 41 (53.2%) patients entered PNP. Compared with non-EMS group, EMS without PNP group greatly shortened the onset to door time (ODT), but EMS with PNP group showed both a significantly shorter DNT (41.3 ± 10.7 min vs 51.9±23.8 min, t=2.583, p=0.012) and ODT (133.2 ± 90.2 min vs 174.8 ± 105.1 min, t=2.228, p=0.027) than non-EMS group. Multivariate analysis showed that the use of EMS with PNP (OR=2.613, p=0.036), but not EMS (OR=1.865, p=0.103), was independently associated with good outcome after adjusting for age and baseline NIHSS score. When adding ONT into the regression model, ONT (OR=0.994, p=0.001), but not EMS with PNP (OR=1.785, p=0.236), was independently associated with good outcome. EMS with PNP, rather than EMS only, improved stroke outcome by shortening ONT. PNP could be a feasible strategy for better stroke care in Chinese urban area.
The present study was retrospectively conducted with a prospectively collected stroke registry of a single stroke center. Our hospital is situated in Hangzhou (size: 701.8 km2), Southeast China, a typical Chinese urban area, with a densely population of 9 million. Our hospital is a tertiary teaching hospital and comprehensive stroke center that treats about 1.8 thousand patients with acute ischemic stroke (AIS) or transient ischemic attack per year.
During one-year period, 42% patients were transferred by EMS and about half of them arrived at our stroke center via PNP. By the implementation of PNP, not only the ODT was reduced, but also the whole in-hospital treatment procedure was greatly speeded up, especially for the time in ED. Therefore, the ONT was visibly shortened, accompanied with better neurological outcome.