Helicopter "Drip and Ship" Flights Do Not Alter the Pharmacological Integrity of rtPA
Helicopter "Drip and Ship" Flights Do Not Alter the Pharmacological Integrity of rtPA
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DOI：
10.1016/j.jstrokecerebrovasdis.2018.05.049
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发表时间：
2018-10-01
影响因子：
2.5
通讯作者：
Leira, Enrique C.
中科院分区：
文献类型：
--
作者：
Faine, Brett A.;Dayal, Sanjana;Leira, Enrique C.
导言：农村和危重医疗机构依靠直升机紧急医疗服务(HEMS)的“点滴和发货”做法。但这些直升机飞行是一个不寻常的环境，具有可能影响IV rtPA稳定性的物理因素，如振动和加速，以及药理学特性，这是一个以前没有解决的问题。材料和方法：这是一项前瞻性队列研究，研究对象是2015年11月至2017年2月在综合卒中中心接受静脉注射rtPA的连续急性缺血性卒中患者，通过收集药瓶中残留的药物来衡量HEMS对rtPA完整性和活性的影响。临床试验注册：http：//www.Clinic Trails.gov.Clinic NCT02752256结果：共纳入33例患者和rtPA样本，18例直接到综合卒中中心急诊科就诊，15例在空中救护车转运过程中接受rtPA治疗。HEMS组残留药瓶中rtPA抗原浓度中位数为3.04 mg/mL(IQR：1.24~3.87)，对照组为1.91 mg/mL(IQR：1.33~2.60)(P=0.168)。HEMS组和对照组rtPA活性或比活性无显著差异，且HEMS总飞行时间与总rtPA比活性无相关性。结论：总而言之，这项研究提供了支持性证据，证明HEMS物理环境对rtPA完整性没有不利影响，因此支持目前的滴注和运输实践，而不需要调整输液。
Introduction: Rural and critical access hospitals rely on the "drip and ship" practice using helicopter emergency medical services (HEMS). But those helicopter flights are an unusual environment with physical factors such as vibration and accelerations that could potentially affect the stability, and pharmacological properties of IV rtPA, an issue that has not been previously addressed. Materials and Methods: This was a prospective cohort study of consecutive acute ischemic stroke patients receiving IV rtPA through a Comprehensive Stroke Center from November 2015 to February 2017 to measure the effects of HEMS on the integrity and activity of rtPA by collecting residual medication left in the vial. Clinical Trial Registration: http:/ /www.clinical trails.gov.clinical NCT02752256 Results: A total of 33 patients and rtPA samples were included; 18 patients who presented directly to the Comprehensive Stroke Center emergency department and 15 patients who received rtPA during air ambulance transfer. The median rtPA antigen concentration in the residual medication vial was 3.04 mg/ mL (IQR: 1.24-3.87) in the HEMS group and 1.91 mg/ mL (IQR: 1.33-2.60) in the controls (P = .168). There were no significant differences in rtPA activity or specific activity between the HEMS and control groups and there was no association between total HEMS flight time on overall rtPA specific activity. Conclusions: In summary, this study provides supportive evidence of the lack of a detrimental effect of the HEMS physical environment on the integrity of rtPA, therefore endorsing current drip and ship practices without infusion adjustments.