1
|
Lund UH, Stoinska-Schneider A, Larsen K, Bache KG, Robberstad B. Cost-Effectiveness of Mobile Stroke Unit Care in Norway. Stroke 2022; 53:3173-3181. [PMID: 35862205 PMCID: PMC9508956 DOI: 10.1161/strokeaha.121.037491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Acute ischemic stroke treatment in mobile stroke units (MSUs) reduces time-to-treatment and increases thrombolytic rates, but implementation requires substantial investments. We wanted to explore the cost-effectiveness of MSU care incorporating novel efficacy data from the Norwegian MSU study, Treat-NASPP (the Norwegian Acute Stroke Prehospital Project).
METHODS:
We developed a Markov model linking improvements in time-to-treatment and thrombolytic rates delivered by treatment in an MSU to functional outcomes for the patients in a lifetime perspective. We estimated incremental costs, health benefits, and cost-effectiveness of MSU care as compared with conventional care. In addition, we estimated a minimal MSU utilization level for the intervention to be cost-effective in the publicly funded health care system in Norway.
RESULTS:
MSU care was associated with an expected quality-adjusted life-year-gain of 0.065 per patient, compared with standard care. Our analysis suggests that about 260 patients with ischemic stroke need to be treated with MSU annually to result in an incremental cost-effectiveness ratio of about NOK385 000 (US$43 780) per quality-adjusted life-year for MSU compared with standard care. The incremental cost-effectiveness ratio varies between some NOK1 000 000 (US$113 700) per quality-adjusted life-year if an MSU treats 100 patients per year and to about NOK340 000 (US$38 660) per quality-adjusted life-year if 300 patients with acute ischemic stroke are treated.
CONCLUSIONS:
MSU care in Norwegian settings is potentially cost-effective compared with conventional care, but this depends on a relatively high annual number of treated patients with acute ischemic stroke per vehicle. These results provide important information for MSU implementation in government-funded health care systems.
Collapse
Affiliation(s)
- Ulrikke Højslev Lund
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway (U.H.L., A.S.-S., B.R.)
| | - Anna Stoinska-Schneider
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway (U.H.L., A.S.-S., B.R.)
| | - Karianne Larsen
- The Norwegian Air Ambulance Foundation, Oslo, Norway (K.L., K.G.B.)
- Institute of Basic Medical Sciences, University of Oslo, Norway (K.L., K.G.B.)
| | - Kristi G. Bache
- The Norwegian Air Ambulance Foundation, Oslo, Norway (K.L., K.G.B.)
- Institute of Basic Medical Sciences, University of Oslo, Norway (K.L., K.G.B.)
- Research and Dissemination, Østfold University College, Halden, Norway (K.G.B.)
| | - Bjarne Robberstad
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway (U.H.L., A.S.-S., B.R.)
- Department of Global Public Health and Primary Care, University of Bergen, Norway (B.R.)
| |
Collapse
|
2
|
Hariharan P, Tariq MB, Grotta JC, Czap AL. Mobile Stroke Units: Current Evidence and Impact. Curr Neurol Neurosci Rep 2022; 22:71-81. [PMID: 35129761 DOI: 10.1007/s11910-022-01170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Several approaches have been developed to optimize prehospital systems for acute stroke given poor access and significant delays to timely treatment. Specially equipped ambulances that directly initiate treatment, known as Mobile Stroke Units (MSUs), have rapidly proliferated across the world. This review provides a comprehensive summary on the efficacy of MSUs in acute stroke, its various applications beyond thrombolysis, as well as the establishment, optimal setting and cost-effectiveness of incorporating an MSU into healthcare systems. RECENT FINDINGS MSUs speed stroke treatment into the first "golden hour" when better outcomes from thrombolysis are achieved. While evidence for the positive impact of MSUs on outcomes was previously unavailable, two recent landmark controlled trials, B_PROUD and BEST-MSU, show that MSUs result in significantly lesser disability compared to conventional ambulance care. Emerging literature prove the significant impact of MSUs. Adaptability however remains limited by significant upfront financial investment, challenges with reimbursements and pending evidence on their cost-effectiveness.
Collapse
Affiliation(s)
- Praveen Hariharan
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin St, MSB 7.044, Houston, TX, 77030, USA
| | - Muhammad Bilal Tariq
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin St, MSB 7.044, Houston, TX, 77030, USA
| | - James C Grotta
- Clinical Innovation and Research Institute, Memorial Hermann Hospital Texas Medical Center, Houston, TX, USA
| | - Alexandra L Czap
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin St, MSB 7.044, Houston, TX, 77030, USA.
| |
Collapse
|
3
|
Fassbender K, Merzou F, Lesmeister M, Walter S, Grunwald IQ, Ragoschke-Schumm A, Bertsch T, Grotta J. Impact of mobile stroke units. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-324005. [PMID: 34035130 PMCID: PMC8292607 DOI: 10.1136/jnnp-2020-324005] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
Since its first introduction in clinical practice in 2008, the concept of mobile stroke unit enabling prehospital stroke treatment has rapidly expanded worldwide. This review summarises current knowledge in this young field of stroke research, discussing topics such as benefits in reduction of delay before treatment, vascular imaging-based triage of patients with large-vessel occlusion in the field, differential blood pressure management or prehospital antagonisation of anticoagulants. However, before mobile stroke units can become routine, several questions remain to be answered. Current research, therefore, focuses on safety, long-term medical benefit, best setting and cost-efficiency as crucial determinants for the sustainability of this novel strategy of acute stroke management.
Collapse
Affiliation(s)
- Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Fatma Merzou
- Department of Neurology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Martin Lesmeister
- Department of Neurology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Silke Walter
- Department of Neurology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Iris Quasar Grunwald
- Department of Neuroscience, Medical School, Anglia Ruskin University, Chelmsford, UK
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, UK
| | | | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Private Medical University-Nuremberg Campus, Nuremberg, Bayern, Germany
| | - James Grotta
- Department of Neurology, Memorial Hermann Hospital, Houston, Texas, USA
| |
Collapse
|
4
|
Neuroimaging of Acute Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10051086. [PMID: 33807843 PMCID: PMC7962049 DOI: 10.3390/jcm10051086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 01/25/2023] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for 10% to 20% of all strokes worldwide and is associated with high morbidity and mortality. Neuroimaging is clinically important for the rapid diagnosis of ICH and underlying etiologies, but also for identification of ICH expansion, often as-sociated with an increased risk for poor outcome. In this context, rapid assessment of early hema-toma expansion risk is both an opportunity for therapeutic intervention and a potential hazard for hematoma evacuation surgery. In this review, we provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome. Specifically, we discuss standard imaging using computed tomography, the value of different vascular imaging modalities to identify underlying causes and present recent advances in magnetic resonance imaging and computed tomography perfusion.
Collapse
|
5
|
Low PH, Mangat MS, Liew DNS, Wong ASH. Neurosurgical Services in the Northern Zone of Sarawak in Malaysia: The Way Forward Amid the COVID-19 Pandemic. World Neurosurg 2020; 144:e710-e713. [PMID: 32949798 PMCID: PMC7494498 DOI: 10.1016/j.wneu.2020.09.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/03/2022]
Abstract
Background The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services, including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo island. Our objectives included discussing the logistic and geographic challenges faced during the COVID-19 pandemic. Methods Miri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined. Results During the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19. Conclusions This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.
Collapse
Affiliation(s)
- Peh Hueh Low
- Department of Neurosurgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
| | | | | | | |
Collapse
|
6
|
Wira CR, Aydin A. Mobile Stroke Units—the Changing Face of Emergency Medicine Stroke Management. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00207-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Upadhyayula PS, Yue JK, Yang J, Birk HS, Ciacci JD. The Current State of Rural Neurosurgical Practice: An International Perspective. J Neurosci Rural Pract 2019; 9:123-131. [PMID: 29456356 PMCID: PMC5812136 DOI: 10.4103/jnrp.jnrp_273_17] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery.
Collapse
Affiliation(s)
- Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jason Yang
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| | - Harjus S Birk
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| | - Joseph D Ciacci
- Department of Neurological Surgery, University of California, San Diego, La Jolla, USA
| |
Collapse
|
8
|
Świeżewski SP, Rzońca P, Panczyk M, Leszczyński PK, Gujski M, Michalak G, Fronczak A, Gałązkowski R. Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study. Med Sci Monit 2019; 25:6547-6553. [PMID: 31473759 PMCID: PMC6738001 DOI: 10.12659/msm.915759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background A stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process. Material/Methods A retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals. Results Helicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients’ condition was the drawing out of the extent of time spent by the crew at the scene. Conclusions The use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.
Collapse
Affiliation(s)
- Stanisław Paweł Świeżewski
- Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.,Polish Medical Air Rescue, Warsaw, Poland
| | - Patryk Rzońca
- Polish Medical Air Rescue, Warsaw, Poland.,Department of Emergency Medicine, Medical University of Lublin, Lublin, Poland
| | - Mariusz Panczyk
- Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Konrad Leszczyński
- Department of Nursing and Emergency Medicine, Faculty of Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland
| | - Mariusz Gujski
- Chair of Public and Environmental Health, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Michalak
- Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.,Polish Medical Air Rescue, Warsaw, Poland
| | - Adam Fronczak
- Department of Public Health, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.,Polish Medical Air Rescue, Warsaw, Poland
| |
Collapse
|
9
|
Tønsager K, Rehn M, Ringdal KG, Lossius HM, Virkkunen I, Østerås Ø, Røislien J, Krüger AJ. Collecting core data in physician-staffed pre-hospital helicopter emergency medical services using a consensus-based template: international multicentre feasibility study in Finland and Norway. BMC Health Serv Res 2019; 19:151. [PMID: 30849977 PMCID: PMC6408770 DOI: 10.1186/s12913-019-3976-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparison of services and identification of factors important for favourable patient outcomes in emergency medical services (EMS) is challenging due to different organization and quality of data. The purpose of the present study was to evaluate the feasibility of physician-staffed EMS (p-EMS) to collect patient and system level data by using a consensus-based template. METHODS The study was an international multicentre observational study. Data were collected according to a template for uniform reporting of data from p-EMS using two different data collection methods; a standard and a focused data collection method. For the standard data collection, data were extracted retrospectively for one year from all FinnHEMS bases and for the focused data collection, data were collected prospectively for six weeks from four selected Norwegian p-EMS bases. Completeness rates for the two data collection methods were then compared and factors affecting completeness rates and template feasibility were evaluated. Standard Chi-Square, Fisher's Exact Test and Mann-Whitney U Test were used for group comparison of categorical and continuous data, respectively, and Kolomogorov-Smirnov test for comparison of distributional properties. RESULTS All missions with patient encounters were included, leaving 4437 Finnish and 128 Norwegian missions eligible for analysis. Variable completeness rates indicated that physiological variables were least documented. Information on pain and respiratory rate were the most frequently missing variables with a standard data collection method and systolic blood pressure was the most missing variable with a focused data collection method. Completeness rates were similar or higher when patients were considered severely ill or injured but were lower for missions with short patient encounter. When a focused data collection method was used, completeness rates were higher compared to a standard data collection method. CONCLUSIONS We found that a focused data collection method increased data capture compared to a standard data collection method. The concept of using a template for documentation of p-EMS data is feasible in physician-staffed services in Finland and Norway. The greatest deficiencies in completeness rates were evident for physiological parameters. Short missions were associated with lower completeness rates whereas severe illness or injury did not result in reduced data capture.
Collapse
Affiliation(s)
- Kristin Tønsager
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Marius Rehn
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Kjetil G. Ringdal
- Department of Anesthesiology, Vestfold Hospital Trust, Tønsberg, Norway
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
- Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
| | - Hans Morten Lossius
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Øyvind Østerås
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jo Røislien
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Andreas J. Krüger
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
| |
Collapse
|
10
|
Mathur S, Walter S, Grunwald IQ, Helwig SA, Lesmeister M, Fassbender K. Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units. Front Neurol 2019; 10:159. [PMID: 30881334 PMCID: PMC6407433 DOI: 10.3389/fneur.2019.00159] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/07/2019] [Indexed: 12/11/2022] Open
Abstract
In acute stroke management, time is brain, as narrow therapeutic windows for both intravenous thrombolysis and mechanical thrombectomy depend on expedient and specialized treatment. In rural settings, patients are often far from specialized treatment centers. Concurrently, financial constraints, cutting of services and understaffing of specialists for many rural hospitals have resulted in many patients being underserved. Mobile Stroke Units (MSU) provide a valuable prehospital resource to rural and remote settings where patients may not have easy access to in-hospital stroke care. In addition to standard ambulance equipment, the MSU is equipped with the necessary tools for diagnosis and treatment of acute stroke or similar emergencies at the emergency site. The MSU strategy has proven to be effective at facilitating time-saving stroke triage decisions. The additional on-board imaging helps to determine whether a patient should be taken to a primary stroke center (PSC) for standard treatment or to a comprehensive stroke center (CSC) for advanced stroke treatment (such as intra-arterial therapy) instead. Diagnosis at the emergency site may prevent additional in-hospital delays in workup, handover and secondary (inter-hospital) transport. MSUs may be adapted to local needs-especially in rural and remote settings-with adjustments in staffing, ambulance configuration, and transport models. Further, with advanced imaging and further diagnostic capabilities, MSUs provide a valuable platform for telemedicine (teleradiology and telestroke) in these underserved areas. As MSU programmes continue to be implemented across the world, optimal and adaptable configurations could be explored.
Collapse
Affiliation(s)
- Shrey Mathur
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
| | - Silke Walter
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
- Neuroscience Unit, Faculty of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Iris Q. Grunwald
- Neuroscience Unit, Faculty of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
- Department of Medicine, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Stefan A. Helwig
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
| | - Martin Lesmeister
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Centre, Homburg, Germany
| |
Collapse
|
11
|
Larsen K, Bache KG, Franer E, Tveit LH, Hov MR, Lund CG, Solyga V, Lossius HM. Pre-hospital thrombolysis of ischemic stroke in the emergency service system-A case report from the Treat-NASPP trial. Acta Anaesthesiol Scand 2019; 63:410-413. [PMID: 30426474 PMCID: PMC6587768 DOI: 10.1111/aas.13285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Karianne Larsen
- The Norwegian Air Ambulance Foundation; Oslo Norway
- Institute of Basic Medical Sciences; University of Oslo; Oslo Norway
| | - Kristi G. Bache
- The Norwegian Air Ambulance Foundation; Oslo Norway
- Institute of Basic Medical Sciences; University of Oslo; Oslo Norway
| | - Eirik Franer
- The Norwegian Air Ambulance Foundation; Oslo Norway
- Department of Anesthesiology; Østfold Hospital; Kalnes Norway
| | - Lars H. Tveit
- Department of Neurology; Østfold Hospital; Kalnes Norway
| | - Maren R. Hov
- The Norwegian Air Ambulance Foundation; Oslo Norway
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - Christian G. Lund
- The Norwegian Air Ambulance Foundation; Oslo Norway
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - Volker Solyga
- Department of Neurology; Østfold Hospital; Kalnes Norway
| | - Hans Morten Lossius
- The Norwegian Air Ambulance Foundation; Oslo Norway
- Department of Health Science; University of Stavanger; Stavanger Norway
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. RECENT FINDINGS Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. SUMMARY There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams.
Collapse
|
13
|
Hov MR, Zakariassen E, Lindner T, Nome T, Bache KG, Røislien J, Gleditsch J, Solyga V, Russell D, Lund CG. Interpretation of Brain CT Scans in the Field by Critical Care Physicians in a Mobile Stroke Unit. J Neuroimaging 2017; 28:106-111. [PMID: 28766306 PMCID: PMC5811888 DOI: 10.1111/jon.12458] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/23/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU). METHODS In this pilot study, 13 anesthesiologists assessed unselected acute stroke patients with a cerebral CT scan in an MSU. The scans were simultaneously available by teleradiology at the receiving hospital and the on‐call radiologist. CT scan interpretation was focused on the radiological diagnosis of acute stroke and contraindications for thrombolysis. The aim of this study was to find inter‐rater agreement between the pre‐ and in‐hospital radiological assessments. A neuroradiologist evaluated all CT scans retrospectively. Statistical analysis of inter‐rater agreement was analyzed with Cohen's kappa. RESULTS Fifty‐one cerebral CT scans from the MSU were included. Inter‐rater agreement between prehospital anesthesiologists and the in‐hospital on‐call radiologists was excellent in finding radiological selection for thrombolysis (kappa .87). Prehospital CT scans were conducted in median 10 minutes (7 and 14 minutes) in the MSU, and median 39 minutes (31 and 48 minutes) before arrival at the receiving hospital. CONCLUSION This pilot study shows that anesthesiologists trained in prehospital critical care may effectively assess cerebral CT scans in an MSU, and determine if there are radiological contraindications for thrombolysis.
Collapse
Affiliation(s)
- Maren Ranhoff Hov
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Zakariassen
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Thomas Lindner
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,The Regional Centre for Emergency Medical Research and Development, Stavanger, Norway
| | - Terje Nome
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Kristi G Bache
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Jo Røislien
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Volker Solyga
- Department of Neurology, Østfold Hospital, Kalnes, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian G Lund
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | -
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway
| |
Collapse
|