Ebinger M, Winter B, Wendt M, et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014;311(16):1622-31.

Does prehospital thrombolysis in specialized ambulances reduce delay to thrombolysis in acute ischemic stroke?

To determine the effect of prehospital thrombolysis for acute ischemic stroke administered in specialized ambulances on delay in thrombolytic administration, thrombolysis rate, post-thrombolysis intracerebral hemorrhage, and 7-day mortality.

To assess the effectiveness of the use of dobutamine hydrochloride in out-of hospital emergency situations.

Patients with severe circulatory insufficiency caused by acute illness or injury encountered by the Mobile Intensive Care Unit of Copenhagen (population 467,000) during a 15-month study period.

A newly developed dobutamine solution was administered by infusion pump to patients in whom normal emergency treatment failed to restore an acceptable circulatory state.

A total of 40 patients were treated with 4–48 μg dobutamine/kg/minute. The treatment was judged to be primary life-saving in 15 patients, the condition was improved in 16 patients, and nine patients died. Systolic blood pressures (in those who survived) rose from a mean value of 45 mmHg (range 0–80 mmHg) to 105 mmHg (range 65–180 mmHg). No tachycardia or arrhythmias were noted.

This newly developed dobutamine solution is very useful in prehospital treatment of patients with circulatory failure and is recommend for use by mobile intensive care unit teams.