MDA to consider German model for mobile stroke units

Mobile CT scan in ambulances can determine whether a patient with symptoms of an ischemic stroke has had one, and dissolve brain clots.

By JUDY SIEGEL-ITZKOVICH
Magen David Adom ambulance 311 (photo credit: REUTERS)
Magen David Adom ambulance 311
(photo credit: REUTERS)
Magen David Adom is examining the possibility of eventually adopting new German technology that installs a mobile computerized tomograhy (CT) scan in ambulances that can determine whether a patient with symptoms of an ischemic stroke has had one, and dissolve clots in the brain before they cause damage.
MDA training department director told The Jerusalem Post that he had transferred the new study to relevant MDA experts.
A preliminary study by neurologists from hospitals in Homburg and Nuremberg in Germany about out-of-hospital treatment of stroke was recently published in the open-access PLoS (Public Library of Science) One journal. If specially trained doctors see on the CT scan in the ambulance that the patient with stroke symptoms is having or about to have a ischemic stroke in which a clot is blocking blood supply to the train, and on-the-spot blood tests confirm it, they can inject a lifesaving drug called rTPA (tissue plasminogen activator) on the spot and can prevent stroke damage.
The CT is needed so that the doctors can be sure he is not having a hemorrhagic stroke; in that case, injecting rTPA that makes the blood flow smoothly could worsen the situation and even kill him. Former prime minister Ariel Sharon, who has been in a deep coma and suffering from lowerbrain death for the past five years, had two strokes, the first ischemic and the second hemorrhagic.
A few thousand Israelis suffer strokes or TIAs (transient ischemic attacks, which often proceed full-fledged strokes) each year. Among the easily recognizable warning signs are being unable to smile, speak or shake someone’s hand. Stroke symptoms include numbness or weakness of the face, arm or leg, especially on one side of the body; confusion, trouble speaking or understanding; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; or severe headache with no known cause – all of them appearing suddenly.
Many people with symptoms delay going to the hospital, thinking that it is not really a stroke and that the symptoms will pass.
But if they are not treated within three hours of onset, the stroke – and disability or death – are almost inevitable.
Prof. Jose Cohen, one of the country’s leading stroke experts who treated Sharon in the stroke unit at Hadassah University Medical Center in Jerusalem’s Ein Kerem, told the Post that the idea of treating stroke victims immediately at home or wherever they are is “revolutionary.”
The German model consisted of a “mobile stroke unit consisting of an ambulance equipped with a CT scan, a point-of-care laboratory system for complete stroke laboratory workup and telemedicine capabilities for contact with hospital experts.”
If it is an ischemic stroke, rTPA thrombolysis can be performed.
The German neurologists concluded that their preliminary study “proves the feasibility of guideline-adherent, etiology-specific and causal treatment of” acute stroke directly at the emergency site.
“More than 90 percent of Israeli stroke patients come late to the hospital, and this delay is the main limitation of stroke therapies,” Cohen said. “I always fantasized having an ambulance with CT that may allow giving rTPA on the field after a brief, basic triage.”
He added that “time is brain” is a largely precise saying. “Clinical outcomes have been shown to deteriorate the longer treatment is delayed.”
Every minute you wait, hoping your symptoms will go away, you lose almost two million brain cells, Cohen said. The brain has 22 billion neurons and in a typical stroke, 120 million neurons and 830 billion synapses are completely lost. In other words, compared to the normal rate of neuron loss in ageing brain, the ischemic brain ages 3.6 years each hour without treatment.
He warned that trying to call your family doctor, son, rabbi or even neurologist is a “waste of time” in these circumstances. “If you are suffering a stroke, you need emergency assistance. You need urgent transfer to the hospital, rapid assessment of a stroke specialist, a head CT and start injection of the anti-clot drug rTPA.
“Imagine this can be done in a special ambulance at the front of your house,” Cohen continued.
The loss of brain cells could be only be arrested if treatment is dispensed immediately, especially if the anti-clot drug is administered within three hours of a stroke. Twenty people from each 100 that suffer a stroke die in the hospital, mainly due to delay in treatment.