The BERLIN_PREHOSPITAL OR USUAL CARE DELIVERY IN ACUTE STROKE (B_PROUD) investigators
In patients with spontaneous acute intracerebral haemorrhage (ICH), ESO guidelines suggest that blood pressure reduction with systolic blood pressure (sBP) target <140mmHg is safe and “should be started as soon and fast as possible”. Through prehospital imaging, Mobile Stroke Units (MSU) enable earlier ICH diagnosis and thereby earlier initiation of blood pressure lowering treatment.
ICH patients were included as a companion cohort in the prospective, controlled B_PROUD-study in Berlin, which primarily estimated effects for ischemic stroke patients. ICH patients within MSU catchment areas were included if onset-to-alarm time was ≤ 6h. MSU availability determined allocation (dispatch of MSU or conventional ambulance alone). We compared first sBP at ambulance arrival with first sBP measured in emergency departments as well as 7-day mortality and 3-month modified Rankin Scale (mRS) scores (range: 0, no neurological deficits, to 6, death; good outcome: 0-2).
From February 1st, 2017 to May 8th, 2019, MSUs were dispatched to 113 ICH patients and conventional ambulances alone to 110 ICH patients (age: 72±13y vs. 71±12y, 48% vs. 42% female, median admission NIHSS: 12±7 vs. 12±8). First prehospital sBP was similar between MSU and conventional groups (176±34 vs. 172±36mmHg), but lower at emergency department arrival (163±34 vs. 179±38mmHg). 7-day mortality was 21% after MSU dispatch and 17% in conventional care (p=0.50). Odds ratio for good outcome at 3-months was 0.81 (95%-CI: 0.42-1.6; p=0.53) after MSU-dispatch.
Although MSU dispatch led to a significant prehospital blood pressure reduction, this did not translate into better outcomes for ICH patients.
NCT02869386