Zusammenfassung
Die Effektivität von Schlaganfalltherapien, wie der Thrombolyse und mechanischen Rekanalisation, ist umso höher, je früher die Therapien begonnen werden. Patienten mit akutem Schlaganfall müssen deshalb durch qualifiziertes Personal so rasch wie möglich auf ihre Eignung für diese Therapien hin untersucht werden. Um die Rettungskette umgehend zu aktivieren, müssen Laien die typischen Symptome des Schlaganfalls kennen und richtig reagieren. Der Rettungsdienst reevaluiert die Symptome und führt den Patienten einer zerebralen Bildgebung zu. Diese wird idealerweise in einem Krankenhaus mit Stroke-Unit durchgeführt, in dem die weitere Behandlung stattfindet. Bereits im Rettungsdienst können neben der Erfassung und Stabilisierung von Vitalparametern wichtige weitere Informationen eingeholt werden. Der genaue Zeitbeginn und Schweregrad der Defizite sowie Begleiterkrankungen und Medikation des Patienten können bereits auf dem Weg in das Krankenhaus erfasst und an das Krankenhaus übermittelt werden. So wird der anschließende intrahospitale Versorgungsprozess entlastet und beschleunigt. Inzwischen gibt es Rettungswagen, die neben qualifiziertem Personal, telemedizinischer Anbindung und Laborschnelltests (z. B. Glukose and INR [International Normalized Ratio]) sogar mit einem Computertomographen (CT) an Bord ausgestattet sind. In diesen Schlaganfalleinsatzmobilen („stroke emergency mobile“, STEMO) kann die Thrombolyse früher und sicher begonnen werden. Eine Behandlung im STEMO könnte der konventionellen Behandlung sogar überlegen sein. Des Weiteren kann im STEMO durch die CT-Angiographie bereits prähospital festgestellt werden, ob ein großer Gefäßverschluss vorliegt. In diesem Fall werden die Patienten dann ohne Umwege in Zentren gebracht, in denen eine mechanische Rekanalisation durchgeführt werden kann.
Abstract
The effectiveness of thrombolysis or mechanical recanalization for acute stroke is higher, the sooner these therapies are started. Therefore, acute stroke patients need to be evaluated by qualified staff for these therapies as soon as possible. Lay persons need to identify the typical symptoms of stroke as an emergency and act accordingly by calling the emergency medical system (EMS). The EMS team reassesses the symptoms and prompts cerebral imaging. Cerebral imaging is performed ideally in hospitals with a stroke unit where subsequent (stroke) treatments occur. On the way, the emergency team will measure and stabilize vital functions and obtain further important clinical information. Telemedicine allows communicating exact time of onset and severity of symptoms, as well as comorbidities and medication of the patient to the respective hospital. Thereby, the intrahospital workload will be disencumbered and accelerated. Some EMS vehicles now carry point-of-care laboratories and may measure lab values en route (glucose and INR [International Normalized Ratio] for example). Some ambulances are not only equipped with qualified staff, telemedicine technique, and point-of-care labs but even computer tomography (CT) to perform imaging. Such mobile stroke emergency mobiles (STEMO) or mobile stroke units may perform thrombolysis prehospitally. Prehospital thrombolysis has been proven to be initiated faster and is safe. Preliminary results even suggest superiority to intrahospital thrombolysis with respect to clinical outcome. Moreover, STEMO may perform CT-angiography and assess intracranial large-vessel status. If intracranial large-vessel occlusion is present, patients will be brought directly to hospitals able to perform mechanical recanalization. Thus, secondary transports are no longer required.
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C. H. Nolte erhielt Vortragshonorare von der Fa. Boehringer Ingelheim (dem Hersteller von Actilyse®, Ingelheim am Rhein, Deutschland). H. J. Audebert erhielt Vortragshonorare von Boehringer Ingelheim (dem Hersteller von Actilyse®) und leitet das Berliner STEMO-Projekt.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Nolte, C.H., Audebert, H.J. Prähospitale Versorgung von Patienten mit Schlaganfall. Med Klin Intensivmed Notfmed 112, 668–673 (2017). https://doi.org/10.1007/s00063-017-0348-z
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DOI: https://doi.org/10.1007/s00063-017-0348-z