Thrombolytic therapy is a very powerful tool that physicians can use to treat these patients if they have an ischemic stroke. The main drug used in thrombolytic therapy is rt-PA, a heavy clot busting drug used in ischemic stroke. t-PA, as it is known in a clinical setting, is a time sensitive drug. If the drug is not administered within 60 minutes of arrival to the hospital, the patient outcomes decrease significantly.
As the study, published by the Acta Paulista de Enfermagem in South America, suggests the most effective solution is educating the public on stroke awareness and the early activation of the EMS system to get these patient to the hospital, diagnosed and treated with drugs like t-PA. The earlier the hospital knows these patients are coming, the sooner they can clear the CT scan, MRI machine and other diagnostic tools that allow clinicians to determine if thrombolytic therapy is appropriate for that certain patient.
Even better than getting the hospital ready is another, very new and innovative way some places, including right here in Aurora, CO, are using to treat stroke patients more time efficiently and effectively. They are called mobile stroke response units, known in Aurora as the Mobile Stroke Treatment Unit (MTSU). This unit is the first of its kind in the Rocky Mountain Region, and according to John Violette of UC Health, “Rather than door-to-needle, it’s symptom-to-needle." The unit is equipped with a full CT scanner and all the thrombolytic clot busting drugs of an ER. The patient can, with this unit, receive t-PA before they even reach the doors of the hospital. As studies like the one mentioned above have shown, the earlier t-PA is administered, the better the outcomes for the patient. If this unit can substantially reduce symptom to needle time, it could save many lives that would have otherwise been lost because of time.
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| Mobile Stroke Treatment Unit and Team: Source |
The idea of having a mobile stroke treatment unit is absolutely fascinating to me and interesting to think that it had not been considered as a possibility sooner. Your personal experience in the Denver emergency department was very similar to what I would experience at work on a typical day as well. The administration of t-PA was one that physicians would try to use if they knew for certain they were within the time frame that it is effective, but when it was too late it made the treatment and prognosis of the patient significantly worse. I think with having the availability of a mobile stroke treatment unit provides for administration of t-PA as quick as possible. Per Bowry et al, in 2015 his team found that over eight weeks of using the MSTU that it was possible for t-PA administration to be done within 60 minutes. With this being the case, it shows continued promise with the growth of accessibility to these mobile units for ischemic stroke treatment to occur in time. It also shows that the efficiency of these units will still rely on the public’s awareness of ischemic strokes and to know what to recognize to call for further assistance.
ReplyDeleteRitvij Bowry, MD; Stephanie Parker, RN; Suja S. Rajan, PhD; Jose-Miguel Yamal, PhD; Tzu-Ching Wu, MD; Laura Richardson, BS; Elizabeth Noser, MD; David Persse, MD; Kamilah Jackson, RT; James C. Grotta, MD. (2015, October 5). Benefits of Stroke Treatment Using a Mobile Stroke Unit Compared With Standard Management. Retrieved from http://stroke.ahajournals.org/content/strokeaha/46/12/3370.full.pdf
Hey Zach! I am curious as to where you did this clinical rotation. I worked as a clinical scribe in the Emergency Department at Swedish Medical Center for almost two years. It is one of the best stroke centers in the country with one of the best “door to needle” times, hence my interest in your article. I am also fascinated by the idea of a mobile stroke unit that could improve outcomes for stroke patients, but I do question a few things. Obviously there are not enough MTSU’s to do this yet, but I think it would be interesting to compare “symptom to t-PA” times if you used one of these units as opposed to if EMS services just took the patient to the hospital. Another concern of mine is keeping the patient outside the facility for a longer period of time. While the MTSU has t-PA and a CT scan, keeping the patient out in the field for a longer period of time makes me nervous incase there are any other complications that the MTSU cannot handle. Finally, not to say that cost should trump the quality of patient care, but it seems to me that this would require a neurologist to be on board one of these units, and that could be very costly. It will be interesting to see the outcomes for stroke patients as more of these units come about.
ReplyDeleteI am so impressed with this post because I did not know this was available in Aurora. As a paramedic, this innovation is incredible. Coming from Albuquerque, NM where we run an average of 127,000 calls/ year in the 911 system I am curious to see how many calls this county responds to, how many of these were "stroke" calls and how many of these activated this unit. I have had the opportunity to treat many patients suffering from acute strokes and I believe having a unit like this respond with us could definitely improve patient outcomes. Do you happen to know what level of providers run this specific unit? Radiologist, CT techs, pharmacist to administer the TPA? Or are there special skills certifications for paramedics available to administer TPA? From the picture above it appears there is at least on one nurse, paramedics, and what appears to be a physician, perhaps a neurologist to diagnose the stroke as soon as the CT is completed. Overall I think this is amazing. Having the ability to scan the patient and start treatment on the way to definitive care is a huge step for pre-hospital emergency medicine and an incredible opportunity to improved patient survival.
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