Abstract 64: Feasibility and safety on intravenous tissue Plasminogen Activator in the Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients - Study (PHANTOM-S) Results of the Phantom-S pilot study

Background: Beneficial effects of intravenous tissue Plasminogen Activator (tPA) in acute ischemic stroke (AIS) are strongly time-dependent. In PHANTOM-S, we use a specialized stroke ambulance equipped with a CT-scanner and point-of-care laboratory in order to shorten time-to-treatment. We report feasibility and safety of the 3-months pilot phase. Methods: The ambulance (staffed by a neurologist, paramedic and technician) is deployed by the dispatch center when the emergency call algorithm yields a suspected acute stroke. The pilot study was restricted to patients able to give informed consent. Preliminary Results: Between February 8 and April 30, 2011, the ambulance was deployed 208 times. Specific medical management was provided for 108 patients. 54 patients (50%) had a stroke while 31 (29%) had other neurological and 23 (21%) non-neurological diseases. 24 (48%) (median-NIHSS: 8; mean-age: 75±12) of 50 patients with AIS ambulance diagnosis received tPA (23 in the pre-hospital setting and one patient after admission for CT dysfunction). One of the tPA treated patients had a final non-stroke diagnosis (sepsis). Mean alarm-to-treatment time of pre-hospital tPA application was 58 minutes (62 minutes including the in-hospital tPA-application) compared to 98 minutes in 50 consecutive patients treated with tPA in Charité hospitals in 2010. Two (8%) of the tPA patients suffered a symptomatic intracranial hemorrhage and one patient (4%) died in-hospital. Technical failures comprised one CT dysfunction and two delayed CT-image transmissions Conclusions: Pre-hospital acute stroke management including tPA-application is feasible and the results suggest a significant shortening of time-to-treatment without obvious safety concerns. Final data will be presented at the ISC.