Research Shows Ways to Speed Stroke Care
Studies looked at improvements in ER, specially equipped ambulance that could deliver clot-busting drug
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"We saw a very clear impact of the program in the speed at which tPA was delivered," said study author Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the UCLA Preventative Cardiology Program and associate chief of the UCLA Division of Cardiology. "It's rare that you see such a change in results before and after an initiative."
In the second study, a German research team in Berlin equipped an ambulance with a CT scanner, a laboratory and a telemedicine connection that would allow paramedics to consult with doctors and start tPA treatment on the road.
This ambulance allowed emergency workers to cut by 25 minutes the time it took for them to administer tPA to a patient, researchers report.
"This pre-hospital strategy has the potential to lop a bigger chunk of time off the time-to-treatment," Grotta said.
It's also much more expensive. A specialized stroke ambulance can cost about $1.4 million, the researchers reported.
"This is an interesting concept that could work, but the cost seems to be a prohibitive factor," said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.
But Grotta noted that such costs are relative. The CT scanner in the ambulance cost about $400,000, he said, and the average cost to treat a stroke is about $200,000.
"You only have to reverse two strokes to cover the cost of the CT scanner, and you're going to save more time than what we can do tweaking the emergency department," Grotta said.
Glatter said he is concerned that efforts to speed up tPA treatment could wind up giving the "potentially dangerous drug" to people who should not receive it.
"Measures that help cut transport time and get patients to qualified providers is really the most important aspect for taking care of these patients," he said. "That's ultimately what's going to be the most effective targeted approach to getting these patients treated."
A third study in the same issue of the journal indicates patient support for quick treatment with tPA.