A Reduction in Time with Electronic Monitoring In Stroke (ARTEMIS): study protocol for a randomised multicentre trial. Issue 6 (27th June 2018)

• Record Type: Journal Article
• Authors: Koster, Gaia T; Nguyen, T Truc My; Groot, Adrien E D; Coutinho, Jonathan M; Bosch, Jan; den Hertog, Heleen M; van Walderveen, Marianne A A; Algra, Ale; Wermer, Marieke J H; Roos, Yvo B; Kruyt, Nyika D
• Other Names: author non-byline.; Kruyt Nyika D author non-byline.; Wermer Marieke JH author non-byline.; Algra Ale author non-byline.; Roos Yvo B author non-byline.; Koster Gaia T author non-byline.; My nguyen T Truc author non-byline.; Van walderveen Marianne AA author non-byline.; de schryver Els LLM author non-byline.; Bosch Jan author non-byline.; Roos Yvo B author non-byline.; Coutinho Jonathan M author non-byline.; Groot Adrien ED author non-byline.; van Schaik Sander M author non-byline.; Kwa Vincent IH author non-byline.; Visser Marieke C author non-byline.; Siegers Arjen author non-byline.; Bongaards Renate author non-byline.; Zandwijk Mark van author non-byline.; den Hertog Heleen M author non-byline.; Golde Alex van author non-byline.; Ijmker Rein author non-byline.; Tilborgh Astrid van author non-byline.; Christenhusz Arjan author non-byline.
• Is Part Of: BMJ open. Volume 8:Issue 6(2018)
• Publication Date: 2018-06-27
• Subjects: acute ischemic stroke -- intravenous thrombolysis -- intra-arterial thrombectomy -- time to treatment -- treatment delay -- total system delay; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2017-020844
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Introduction: Time is the most crucial factor limiting efficacy of intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT). The delay between alarming the Emergency Medical Services (EMS) dispatch office and IVT/IAT initiation, that is, the 'total system delay' (TSD), depends on logistics and team effort. A promising method to reduce TSD is real-time audio-visual feedback to caregivers involved. With 'A Reduction in Time with Electronic Monitoring in Stroke' (ARTEMIS), we aim to investigate the effect of real-time audio-visual feedback on actual TSD to IVT/IAT to caregivers. Methods and analysis: ARTEMIS is a multiregional, multicentre, randomised open end-point trial including patients ≥18 years considered IVT/IAT-eligible by the EMS dispatch office or on-site EMS personnel. Patients are electronically tracked and randomised for real-time audio-visual feedback on TSD to caregivers via premounted handhelds and tablets throughout the TSD trajectory. Primary outcome is TSD to IVT/IAT. Secondary outcomes comprise proportion of IVT/IAT-treated patients, symptomatic intracerebral haemorrhage, IVT/IAT-treated stroke mimics, clinical outcome after three months and cost-effectiveness. Separate analyses for IAT-patients with or without prior IVT, within or out of office hours and EMS region will be performed. With 75 IAT-patients and 225 IVT-patients in each arm, we will be able to demonstrate a 20 min difference in TSD to IAT and a 10 min difference in TSD to IVT (p=0.05 and power=0.8). Ethics and dissemination: Study findings will be disseminated through peer-reviewed journals and (inter)national conference presentations. Trial registration number: NCT02808806; Pre-results.