A prospective observational study of why people are medically evacuated from offshore installations in the North Sea

Objectives - Few studies have described evacuations due to medical emergencies from the offshore installations in the North Sea, though efficient medical service is essential for the industrial activities in this area. The major oil- and gas-producing companies’ search and rescue (SAR) service is responsible for medical evacuations. Using a prospective approach, we describe the characteristics of patients evacuated by SAR. Design and setting - A prospective observational study of the offshore primary care provided by SAR in the North Sea. Methods - Patients were identified by linking flight information from air transport services in 2015/2016 and the company’s medical record system. Standardised forms filled out by SAR nurses during the evacuation were also analysed. In-hospital information was obtained retrospectively from Haukeland University Hospital’s information system. Results - A total of 381 persons (88% men) were evacuated during the study period. Twenty-seven per cent of missions were due to chest pain and 18% due to trauma. The mean age was 46.0 years. Severity scores were higher for cases due to medical conditions compared with trauma, but the scores were relatively low compared with onshore emergency missions. The busiest months were May, July and December. Weekends were the busiest days. Conclusion - Three times as many evacuations from offshore installations are performed due to acute illness than trauma, and cardiac problems are the most common. Although most patients are not severely physiologically deranged, the study documents a need for competent SAR services 24 hours a day year-round. Training and certification should be tailored for the SAR service, as the offshore health service structure and geography differs from the structure onshore

A prospective observational study of why people are medically evacuated from offshore installations in the North Sea

Objectives Few studies have described evacuations due to medical emergencies from the offshore installations in the North Sea, though efficient medical service is essential for the industrial activities in this area. The major oil- and gas-producing companies’ search and rescue (SAR) service is responsible for medical evacuations. Using a prospective approach, we describe the characteristics of patients evacuated by SAR. Design and setting A prospective observational study of the offshore primary care provided by SAR in the North Sea. Methods Patients were identified by linking flight information from air transport services in 2015/2016 and the company’s medical record system. Standardised forms filled out by SAR nurses during the evacuation were also analysed. In-hospital information was obtained retrospectively from Haukeland University Hospital’s information system. Results A total of 381 persons (88% men) were evacuated during the study period. Twenty-seven per cent of missions were due to chest pain and 18% due to trauma. The mean age was 46.0 years. Severity scores were higher for cases due to medical conditions compared with trauma, but the scores were relatively low compared with onshore emergency missions. The busiest months were May, July and December. Weekends were the busiest days. Conclusion Three times as many evacuations from offshore installations are performed due to acute illness than trauma, and cardiac problems are the most common. Although most patients are not severely physiologically deranged, the study documents a need for competent SAR services 24 hours a day year-round. Training and certification should be tailored for the SAR service, as the offshore health service structure and geography differs from the structure onshore

A pragmatic approach to sonothrombolysis in acute ischaemic stroke: The Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS)

Background: Ultrasound accelerates thrombolysis with tPA (sonothrombolysis). Ultrasound in the absence of tPA also accelerates clot break-up (sonolysis). Adding intravenous gaseous microbubbles may potentiate the effect of ultrasound in both sonothrombolysis and sonolysis. The Norwegian Sonothrombolysis in Acute Stroke Study aims in a pragmatic approach to assess the effect and safety of contrast enhanced ultrasound treatment in unselected acute ischaemic stroke patients. Methods/Design: Acute ischaemic stroke patients ≥18 years, with or without visible arterial occlusion on computed tomography angiography (CTA) and treatable ≤ 4½ hours after symptom onset, are included in NOR-SASS. NOR-SASS is superimposed on a separate trial randomising patients with acute ischemic stroke to either tenecteplase or alteplase (The Norwegian Tenecteplase Stroke Trial NOR-TEST). The NOR-SASS trial has two arms: 1) the thrombolysis-arms (NOR-SASS A and B) includes patients given intravenous thrombolysis (tenecteplase or alteplase), and 2) the no-thrombolysis-arm (NOR-SASS C) includes patients with contraindications to thrombolysis. First step randomisation of NOR-SASS A is embedded in NOR-TEST as a 1:1 randomisation to either tenecteplase or alteplase. Second step NOR-SASS randomisation is 1:1 to either contrast enhanced sonothrombolysis (CEST) or sham CEST. Randomisation in NOR-SASS B (routine alteplase group) is 1:1 to either CEST or sham CEST. Randomisation of NOR-SASS C is 1:1 to either contrast enhanced sonolysis (CES) or sham CES. Ultrasound is given for one hour using a 2-MHz pulsed-wave diagnostic ultrasound probe. Microbubble contrast (SonoVue®) is given as a continuous infusion for ~30 min. Recanalisation is assessed at 60 min after start of CEST/CES. Magnetic resonance imaging and angiography is performed after 24 h of stroke onset. Primary study endpoints are 1) major neurological improvement measured with NIHSS score at 24 h and 2) favourable functional outcome defined as mRS 0–1 at 90 days. Discussion: NOR-SASS is the first randomised controlled trial designed to test the superiority of contrast enhanced ultrasound treatment given ≤4½ hours after stroke onset in an unselected acute ischaemic stroke population eligible or not eligible for intravenous thrombolysis, with or without a defined arterial occlusion on CTA. If a positive effect and safety can be proven, contrast enhanced ultrasound treatment will be an option for all acute ischaemic stroke patients. EudraCT No 201200032341; www.​clinicaltrials.​gov NCT01949961

The Norwegian tenecteplase stroke trial (NOR-TEST): randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke

Background: Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. Methods/Design: NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4 mg/kg (single bolus) as compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted <4½ hours after symptoms onset; b) admitted <4½ hours after awakening with stroke symptoms c) receiving bridging therapy before embolectomy. Randomisation tenecteplase:alteplase is 1:1. The primary study endpoint is favourable functional outcome defined as modified Rankin Scale 0–1 at 90 days. Secondary study endpoints are: 1) haemorrhagic transformation (haemorrhagic infarct/haematoma); 2) symptomatic cerebral haemorrhage on CT 24–48 hours; 3) major neurological improvement at 24 hours; 4) recanalisation at 24–36 hours; 5) death. Discussion: NOR-TEST may establish a novel approach to acute ischaemic stroke treatment. A positive result will lead to a more effective, safer and easier treatment for all acute ischaemic stroke pasients. NOR-TEST is reviewed and approved by the Regional Committee for Medical and Health Research Ethics (2011/2435), and The Norwegian Medicines Agency (12/01402). NOR-TEST is registered with EudraCT No 2011-005793-33 and in ClinicalTrials.gov (NCT01949948)