How FAST are we? A systematic review and meta- analysis of the effectiveness of intervention done on paramedic services in increasing thrombolysis rate

Objectives: The paramedics’ role is pivotal in ensuring eligible stroke patients reach the hospital within 4.5 hours, as this increases the chance of patients being treated with recombinant tissue plasminogen activator (rTPA) and improves their outcome. The lack of reviews on interventions done on paramedic services and the outcomes associated with them necessitates further investigation to enable policymakers to make guided decisions in improving the management of acute ischaemic strokes. Hence, our study aimed to identify interventions done and their impact on thrombolysis rate and onset-to-door (OTD) time. Methods: We searched PubMed, Embase, CINAHL and RCN to identify studies published between 1 January 2010 and 30 June 2020. The primary outcome of this study is investigating the impact of interventions done on paramedics services on the rTPA administration rate and OTD timing. Other outcomes include improvement in door-to-needle (DTN), door-to-imaging (DTI) and onset- to-needle (OTN) time. Random effect models were used to analyse the effects of the interventions carried out. Results: We gathered 621 papers, of which 11 met the eligibility criteria. The interventions carried out were bypass (n=3), education (n=2), pre-notification (n=4) and telemedicine (n=2). Based on the random effect model, rTPA administration was significantly higher in the intervention arm of ischemic stroke patients (n=7) with an OR of 1.45 (95%CI, 1.01-2.06). The trend was significantly higher with bypass intervention (OR 2.23 95%CI, 1.55-3.2), while the result with pre-notification (OR 0.53 95%CI, 0.09-2.95) and education (OR 1.51 95%CI, 0.87-2.60) were not significant. Conclusions: Paramedic interventions appear to have considerable effectiveness in improving the rates of rTPA, especially when the interventions used bypass mechanisms. This study provides detailed information on the net and quantitative benefits of the interventions and suggests the use of such interventions to reduce the pre-hospital delay of stroke patients and improve the rates of intravenous thrombolysis.