Pre-hospital imaging and thrombolysis in acute stroke in an urban US setting: results of the Cleveland Pre-Hospital Acute Stroke Treatment (PHAST) study group. (S21.002)

BACKGROUND/OBJECTIVE: Favorable outcomes in acute ischemic stroke patients are strongly dependent on reducing time from symptom onset to intravenous tissue plasminogen activator (tPA) treatment. A mobile stroke treatment unit (MSTU) utilizes a modified emergency response vehicle and medical team to respond to patients with acute stroke symptoms. We compared times from dispatch, to arrival, ‘door’, imaging, and tPA treatment for patients with MSTU to traditional emergency medical service (EMS) response. DESIGN/METHODS: MSTU operates between 08:00-20:00 hours and covered the City of Cleveland. The MSTU is equipped with a mobile CT scan and telemedicine equipment and is staffed by a nurse, paramedic, emergency medical technician, and a CT technologist. Stroke physician and neuroradiologist evaluate the patient and images remotely. Non-parametric Wilcoxon rank-sum test compared median times for MSTU patients and control patients arriving at the emergency department (ED) at our stroke center by Cleveland City EMS during the same daytime hours from January 1, 2014. RESULTS: Over the first 12 week period there were 72 PHAST patients, which were compared to 26 ED patients. Time from dispatch to ‘door’ was 20 minutes shorter on average for MSTU versus ED patients (median: 18.5 vs 36 minutes, P=2.4x10-13). CT scan being read was 13 minutes shorter on average for MSTU versus ED patients (median: 44 vs 57 minutes, P=5.5x10-6). Acute stroke treatment was provided in 19[percnt] (13 tPA, 1 Kcentra warfarin reversal for intracerebral hemorrhage) of MSTU patients. tPA was administered significantly earlier for MSTU patients compared to ED patients, on average 28.5 minutes earlier (median: 56 vs 85 minutes, P=0.024). CONCLUSIONS: Close to a fifth of patients received acute stroke treatment on MSTU. These findings demonstrate the successful reduction in time to diagnosis and treatment of acute stroke patients using a MSTU. Study Supported by: Disclosure: Dr. Briggs has nothing to disclose. Dr. Taqui has nothing to disclose. Dr. Cerejo has nothing to disclose. Dr. Itrat has nothing to disclose. Dr. Donohue has nothing to disclose. Dr. Organek has nothing to disclose. Dr. Buletko has nothing to disclose. Dr. Sheikhi has nothing to disclose. Dr. Buttrick has nothing to disclose. Dr. Khawaja has nothing to disclose. Dr. Wisco has nothing to disclose. Dr. Winners has nothing to disclose. Dr. Reimer has nothing to disclose. Dr. Frontera has nothing to disclose. Dr. Manno has nothing to disclose. Dr. Hustey has nothing to disclose. Dr. Kralovic has nothing to disclose. Dr. Peter has nothing to disclose. Dr. Hussain has nothing to disclose. Dr. Uchino has nothing to disclose.