The effect of prehospital notification by emergency medical service on outcomes in patients receiving recombinant tissue-type plasminogen activator (r-tPA)

Shahram  Rafie; Narges  Mofrad-Booshehri; Davood  Shalil-Ahmadi; Elham  Maraghi

doi:10.18502/cjn.v21i2.10497

Shahram Rafie Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Narges Mofrad-Booshehri Student Research Committee, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Davood Shalil-Ahmadi Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Elham Maraghi Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

DOI: https://doi.org/10.18502/cjn.v21i2.10497

Keywords: Thrombosis; Emergency Medical Services; Treatment Outcome; Tissue Plasminogen Activator

Abstract

Background: According to the American Heart Association and American Stroke Association (AHA/ASA) guidelines, in acute stroke, the door-to-computed tomography (CT) scan (DTC) time should be less than 25 minutes, and time to injection of recombinant tissue-type plasminogen activator
(r-tPA) [door-to-needle (DTN) time] should be less than 60 minutes.

Methods: We had a tendency to prospectively collect the clinical and time information of patients who received r-tPA during one year after the initiation of prehospital notification (PN). Patients were divided into three groups, covering patients transferred by Emergency Medical Service (EMS) with and without PN, and non-EMS. We then contrasted the impact of EMS with PN and EMS use on onset-to-needle time (ONT), and the neurological outcome. Good outcome was determined as Modified Rankin Scale (MRS) ≤ 2 at 3-month follow-up.

Results: Among 102 studied patients, 64% were transferred by EMS, of whom 53.9% entered PN. Compared with non-PN groups, EMS with PN group showed significantly shorter DTN and DTC time, as well as ONT.

Conclusion: Our study showed that EMS with PN, rather than EMS, significantly improved stroke outcome by shortening of ONT.