Telemedicine brings prehospital thrombolysis closer

By Eleanor McDermid, Senior medwireNews Reporter

Telemedicine allows prehospital stroke assessment and thrombolysis without the need for a neurologist at the scene, a study shows.

In an editorial accompanying the report in JAMA Neurology, Martin Ebinger and Heinrich Audebert, both from Charité–Universitätsmedizin Berlin in Germany, say that the “occasionally emotional debate about prehospital thrombolysis usually revolves around the wise use of limited resources”, with opponents arguing against sending vascular neurologists “on missions with uncertain outcome”.

In the present study, a neurologist was not present in the mobile stroke treatment unit (MSTU), but telemedicine consultation was successful for 99 of the 100 patients with suspected stroke, report Ken Uchino (Cleveland Clinic, Ohio, USA) and co-researchers. The one unsuccessful case was because the MSTU crew failed to switch on the power supply to the telemedicine station.

Ebinger and Audebert say: “Obviously, replacing a personal encounter with a telemedicine consultation has its limitations. However, in a time-critical scenario such as stroke, the advantages of fast decisions about thrombolysis or thrombectomy may outweigh the shortcomings.”

But they also highlight that there were six video disconnections. Five of the disconnections occurred in areas with poor mobile reception, and all six lasted less than 60 seconds and were not considered harmful to patient care, but the editorialists say that they “sound a note of caution”, and imply that better mobile coverage will be needed for MSTUs to be truly reliable.

The time between patients entering the MSTU and video log-in was a median of 11 minutes; the video log-in duration was a median of 20 minutes and involved consultation with a vascular neurologist and review of computed tomography (CT) images, taken in the MSTU, by a neuroradiologist.

On-board CT was possible in 99 of the patients; the other patient required advanced life support so could not undergo CT. There were delays to acquisition and reading of CT images for five patients – three because of patient agitation and two because of network delays.

The median time between MSTU entry and intravenous thrombolysis, for patients who received it, was 32 minutes, which was faster than the median 58-minute door-to-thrombolysis time seen in 56 control patients who were transported to the emergency department by ambulance.

And the team stresses that one patient received thrombolysis within 11 minutes of MSTU entry, “which highlights the potential application of MSTUs in delivering early thrombolysis to patients with stroke thereby reducing disability.”

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