Helicopter “Drip and Ship” Flights Do Not Alter the Pharmacological Integrity of rtPA

Faine, Brett; Dayal, Sanjana; Kumar, Rahul; Lentz, Steven R.; Leira, Enrique C.

doi:10.1016/j.jstrokecerebrovasdis.2018.05.049

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…When alteplase concentrations during air ambulance transfer were compared with control samples from routine emergency department care, there were no significant differences in alteplase activity. 13 Others have used alteplase solutions ranging from 0.03 to 0.2 mg per mL analyzed by liquid chromatography-mass spectrometry (LC-MS), and they showed degradation ranging from 0% to 36% in peptide concentrations at 24 hours. 14 Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated preparations with alteplase 2-mg vials, which is the most likely formulation to be used in USCDT, rather than alteplase 50-mg or 100-mg vials used in previous studies. 10,13 We also performed our assays to correspond to the administration durations in the OPTALYSE PE trial, extending to 2, 4, and 6 hours rather than limiting the analysis to 0, 6, or 60 minutes. 11,12,14 Our study has operational and clinical implications.…”

Section: Discussionmentioning

confidence: 99%

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Stability of alteplase for ultrasound-facilitated catheter-directed thrombolysis

et al. 2021

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Introduction Ultrasound-facilitated catheter-directed thrombolysis is used with low-dose alteplase to treat pulmonary embolism. This reduces the bleeding risk that accompanies systemic administration of higher alteplase doses. While studies suggest that alteplase given over 2 to 6 hours is safe and effective, few data exist to support alteplase stability under these conditions. Therefore, we undertook this in vitro study to determine the duration of alteplase stability. Methods Alteplase was prepared in solutions of 8 mg in 100 mL, 6 mg in 150 mL, and 8 mg in 200 mL. Solutions were administered through the EkoSonicTM Endovascular System with and without ultrasound, to simulate administration over 2, 4, and 6 hours. Alteplase was assessed with reversed-phase high-performance liquid chromatography (RP-HPLC). Assays were performed at time 0 and at 30-minute intervals during simulated infusion. An enzyme-linked immunosorbent assay (ELISA) assay was used to measure alteplase concentrations that were at time 0 and at 15-minute intervals during simulated infusion. Results Using RP-HPLC, in the absence of ultrasound, the alteplase concentration remained within 1% of the original concentration through 120, 240, and 360 minutes of infusion. Using RP-HPLC for measurement, alteplase, in the presence of ultrasound, degraded steadily over time to approximately 90%, 80%, and 70% of its original amounts in 120, 240, and 360 minutes, respectively. Alteplase that remained was available for enzymatic activity. Conclusions Alteplase solutions of 0.04 and 0.08 mg/mL degraded steadily over time during simulated ultrasound-facilitated catheter-directed administration. Alteplase that did not degrade remained available for enzymatic activity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stability of alteplase for ultrasound-facilitated catheter-directed thrombolysis

et al. 2021

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“…The adaptability of this helicopter is useful because it is able to fly even at night or in bad weather. However, although the speed and safety of helicopter flight for the drip and ship method has been previously demonstrated, 1 , 8) one problem with the helicopter is the inevitably greater loss of time during the request to departure process for each flight, as compared with other transportation methods, such as ambulance. Furthermore, reassigning a helicopter that has arrived so that it can be used for transport onward to the next hospital, in the same way as is possible with an ambulance, is difficult.…”

Section: Discussionmentioning

confidence: 99%

Toward Inter-isolated Island Cooperation for the Drip, Ship, and Retrieve Method in the Sakishima Islands: A Case Report

Wakuta

Yamamoto

Adachi

et al. 2020

JNET

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Based on the findings of preferable outcomes from recanalization therapy in recent studies, regional partnerships for the endovascular treatment of acute ischemic stroke are being promoted. However, reports of interisland cooperation between remote islands located far from high-volume centers on the mainland are rare.Case Presentation: A 63-year-old man experienced an acute ischemic stroke on a small, isolated island in Okinawa, Japan. He was transferred by helicopter to the primary emergency hospital on Ishigaki Island, which was the nearest island on which he could be administered recombinant tissue plasminogen activator (rtPA). After this, he was carried again by helicopter and ambulance to the primary stroke center on Miyako Island using the drip and ship method. Mechanical thrombectomy with a stent retriever achieved recanalization of the occluded major vessels and improved the neurological disturbance. The patient became neurologically independent and could be discharged only 11 days after onset. Conclusion:Building a local area network that includes hospitals providing mechanical thrombectomy is a meaningful approach to treating acute ischemic stroke occurring on isolated islands. It is necessary to recognize the specific restrictions imposed by helicopter transportation and to make efforts to shorten the time required for key processes to provide faster treatment.Keywords▶ DSR (drip, ship, and retrieve), endovascular treatment, Sakishima Islands, acute ischemic stroke, medical care system during which the required treatment has to occur. Thus, the challenge of providing suitable transportation for such patients continues in Japan, leading to the introduction of the drip, ship, and retrieve (DSR) method. 1,2) Recent clinical studies have reported good outcomes for acute cerebral infarction patients receiving mechanical thrombectomy, even more than 6 hours after onset, based on an appropriate indication. 3,4) On the basis of these findings, the guidelines for the early management of acute ischemic stroke patients by the American Heart Association were revised and the indication time for mechanical thrombectomy was extended in 2018. 5) Thus, it is anticipated that the likelihood of patients living on isolated islands receiving emergent endovascular therapy will increase, and that there will be more need to build regional partnerships. A previous report described a partnership established between a high-volume stroke center on the mainland and hospitals on remote islands in Japan 1) ; however, thus far, reports of inter-isolated island cooperation for acute ischemic stroke have been rare. Here, we present the first case treated from the Sakishima Islands as part of an inter-island cooperation project.This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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“…The helicopter typically presents an unavoidable vibration in the range of 0.5–120 Hz. Researchers [ 68 , 69 ] have been concerned that the vibrating transport might have a negative effect on outcomes and so studied the effects finding that there is no negative effect. However, they did not consider that there might be a positive outcome and did not record the dominant vibration frequencies or control for them.…”

Section: Hemodynamic Effectsmentioning

confidence: 99%

Possible Mechanisms for the Effects of Sound Vibration on Human Health

Bartel

Mosabbir

2021

Healthcare

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This paper presents a narrative review of research literature to “map the landscape” of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1–16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.

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Helicopter “Drip and Ship” Flights Do Not Alter the Pharmacological Integrity of rtPA

Abstract: 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.

Cited by 9 publications

References 18 publications

Stability of alteplase for ultrasound-facilitated catheter-directed thrombolysis

Stability of alteplase for ultrasound-facilitated catheter-directed thrombolysis

Toward Inter-isolated Island Cooperation for the Drip, Ship, and Retrieve Method in the Sakishima Islands: A Case Report

Possible Mechanisms for the Effects of Sound Vibration on Human Health

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