Prehospital stroke care: telemedicine, thrombolysis and neuroprotection

Abstract

Over the last 15 years, new approaches regarding neuroprotective and thrombolytic strategies in stroke management have been evaluated in the prehospital setting. These efforts have provided exciting new potentials of hyperacute stroke care. Trials have shown that the use of specialized stroke ambulances increases the proportion of patients receiving intravenous thrombolysis and shortens alarm-to-treatment time by approximately half an hour compared to standard care. Intravenous thrombolysis within the ultra-early time window of the ‘golden hour’ has become a realistic scenario. However, direct effects of prehospital stroke care on functional outcome have yet to be shown and other approaches such as neuroprotective treatments could not demonstrate clinical benefit so far. There is a clear need for systematic research in the prehospital field to test the clinical effectiveness and cost–effectiveness of new therapeutic strategies. It will be necessary to test various components of prehospital stroke care alone and in combination.

Keywords:

• endovascular treatment
• hemorrhagic stroke
• ischemic stroke
• neuroprotection
• prehospital stroke care
• stroke ambulance
• thrombolysis

Financial & competing interests disclosure

HJ Audebert has received speakers honoraria from BMS, Lundbeck Pharma, Pfizer, Sanofi, EVER Neuropharma and Boehringer Ingelheim. HJ Audebert has served as a consultant/advisor for Roche Diagnostics, Lundbeck Pharma and Bayer Vital. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed..

Key issues

• Research on prehospital stroke care focuses on optimizing the dispatcher algorithm, establishing telemedicine techniques, implementing specialized stroke ambulances and evaluating new treatment approaches.

• Telemedicine approaches require reliable real-time connections.

• Specialized stroke ambulances were evaluated in two independent studies which showed a significant improvement of the onset-to-treatment time and thrombolysis rate.

• The use of new drugs with neuroprotective effects requires a standardized transfer process from bench to bedside following the Stroke Therapy Academic Industry Roundtable recommendations.