Melbourne Mobile Stroke Unit and Reperfusion Therapy: Greater Clinical Impact of Thrombectomy Than Thrombolysis.

Aged Aged, 80 and over Ambulances Computed Tomography Angiography Emergency Medical Services Female Humans Male Middle Aged Mobile Health Units Reperfusion Stroke / therapy Thrombectomy Thrombolytic Therapy Time Factors Victoria
aged hospitals humans stroke workflow

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
03 2020
Historique:
pubmed: 23 2 2020
medline: 23 6 2020
entrez: 21 2 2020
Statut: ppublish

Résumé

Background and Purpose- Mobile stroke units (MSUs) are increasingly used worldwide to provide prehospital triage and treatment. The benefits of MSUs in giving earlier thrombolysis have been well established, but the impacts of MSUs on endovascular thrombectomy (EVT) and effect on disability avoidance are largely unknown. We aimed to determine the clinical impact and disability reduction for reperfusion therapies in the first operational year of the Melbourne MSU. Methods- Treatment time metrics for MSU patients receiving reperfusion therapy were compared with control patients presenting to metropolitan Melbourne stroke units via standard ambulance within MSU operating hours. The primary outcome was median time difference in first ambulance dispatch to treatment modeled using quantile regression analysis. Time savings were subsequently converted to disability-adjusted life years avoided using published estimates. Results- In the first 365-day operation of the Melbourne MSU, prehospital thrombolysis was administered to 100 patients (mean age, 73.8 years; 62% men). The median time savings per MSU patient, compared with the control cohort, was 26 minutes (

Identifiants

DOI: 10.1161/STROKEAHA.119.027843 PMID: 32078483
pubmed: 32078483
doi: 10.1161/STROKEAHA.119.027843
doi:

Types de publication

Comparative Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

922-930

Auteurs

Henry Zhao (H)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Ambulance Victoria, Melbourne, Victoria, Australia (H.Z., M.S., K.S., S.B., N.Y., B.C.V.C.).

Skye Coote (S)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Damien Easton (D)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Francesca Langenberg (F)

Department of Radiology (F.L., P.M.D., R.J.D., P.J.M., B.Y.), Royal Melbourne Hospital, Victoria, Australia.

Michael Stephenson (M)

Ambulance Victoria, Melbourne, Victoria, Australia (H.Z., M.S., K.S., S.B., N.Y., B.C.V.C.).

Karen Smith (K)

Ambulance Victoria, Melbourne, Victoria, Australia (H.Z., M.S., K.S., S.B., N.Y., B.C.V.C.).
Department of Epidemiology and Preventive Medicine (K.S.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.
Department of Community Emergency Health and Paramedic Practice (K.S.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.
Discipline of Emergency Medicine, University of Western Australia, Australia (K.S., S.B.).

Stephen Bernard (S)

Ambulance Victoria, Melbourne, Victoria, Australia (H.Z., M.S., K.S., S.B., N.Y., B.C.V.C.).
Discipline of Emergency Medicine, University of Western Australia, Australia (K.S., S.B.).

Dominique A Cadilhac (DA)

Stroke Division, The Florey Institute of Neuroscience and Mental Health (D.A.C., J.K., C.F.B., V.T., N.Y., G.A.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Translational Public Health Research Division, Stroke and Ageing Research Group, School of Clinical Sciences Department of Neurology (D.A.C., J.K.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Joosup Kim (J)

Stroke Division, The Florey Institute of Neuroscience and Mental Health (D.A.C., J.K., C.F.B., V.T., N.Y., G.A.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Translational Public Health Research Division, Stroke and Ageing Research Group, School of Clinical Sciences Department of Neurology (D.A.C., J.K.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Christopher F Bladin (CF)

Stroke Division, The Florey Institute of Neuroscience and Mental Health (D.A.C., J.K., C.F.B., V.T., N.Y., G.A.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Eastern Health, Faculty of Medicine, Nursing and Health Sciences (C.F.B., H.M.D.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Leonid Churilov (L)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine, Austin Health, Melbourne Medical School (L.C.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Douglas E Crompton (DE)

Department of Neurology, Northern Health, Faculty of Medicine, Dentistry and Health Sciences (D.E.C.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Helen M Dewey (HM)

Eastern Health, Faculty of Medicine, Nursing and Health Sciences (C.F.B., H.M.D.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Lauren M Sanders (LM)

Department of Neurology St. Vincent's Hospital Melbourne, Faculty of Medicine, Dentistry and Health Sciences (L.M.S.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Tissa Wijeratne (T)

Department of Neurology, Western Health, Faculty of Medicine, Dentistry and Health Sciences (T.W.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Geoffrey Cloud (G)

Alfred Health (G.C.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.
Department of Clinical Neurosciences, Central Clinical School (G.C.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Duncan M Brooks (DM)

Department of Radiology (D.M.B., H.A.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Hamed Asadi (H)

Department of Radiology (D.M.B., H.A.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Vincent Thijs (V)

Stroke Division, The Florey Institute of Neuroscience and Mental Health (D.A.C., J.K., C.F.B., V.T., N.Y., G.A.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Department of Neurology (V.T.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Ronil V Chandra (RV)

Department of Radiology (R.V.C.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Henry Ma (H)

Department of Neurology (H.M.), Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia.

Patricia M Desmond (PM)

Department of Radiology (F.L., P.M.D., R.J.D., P.J.M., B.Y.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Richard J Dowling (RJ)

Department of Radiology (F.L., P.M.D., R.J.D., P.J.M., B.Y.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Peter J Mitchell (PJ)

Department of Radiology (F.L., P.M.D., R.J.D., P.J.M., B.Y.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Nawaf Yassi (N)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Stroke Division, The Florey Institute of Neuroscience and Mental Health (D.A.C., J.K., C.F.B., V.T., N.Y., G.A.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Ambulance Victoria, Melbourne, Victoria, Australia (H.Z., M.S., K.S., S.B., N.Y., B.C.V.C.).

Bernard Yan (B)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Radiology (F.L., P.M.D., R.J.D., P.J.M., B.Y.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Bruce C V Campbell (BCV)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Ambulance Victoria, Melbourne, Victoria, Australia (H.Z., M.S., K.S., S.B., N.Y., B.C.V.C.).

Mark W Parsons (MW)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Geoffrey A Donnan (GA)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Stroke Division, The Florey Institute of Neuroscience and Mental Health (D.A.C., J.K., C.F.B., V.T., N.Y., G.A.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

Stephen M Davis (SM)

From the Department of Neurology, Melbourne Brain Centre (H.Z., S.C., D.E., L.C., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Royal Melbourne Hospital, Victoria, Australia.
Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences (H.Z., S.C., D.E., P.M.D., R.J.D., P.J.M., N.Y., B.Y., B.C.V.C., M.W.P., G.A.D., S.M.D.), Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Ambulances › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Angiographie par tomodensitométrie › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services de médecine préventive › Services de diagnostic › Unités sanitaires mobiles › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Techniques d'investigation › Perfusion › Reperfusion › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement thrombolytique › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Phénomènes physiques › Temps › Facteurs temps › Melbourne Mobile Stroke Unit and Reperfusion...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Victoria › Melbourne Mobile Stroke Unit and Reperfusion...