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Current Neurology and Neuroscience Reports
Published in: Current Neurology and Neuroscience Reports 11/2014

01-11-2014 | Critical Care (SA Mayer, Section Editor)

Strategies for Streamlining Emergency Stroke Care

Authors: Keith G. DeSousa, Diogo C. Haussen, Dileep R. Yavagal

Published in: Current Neurology and Neuroscience Reports | Issue 11/2014

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Abstract

There has been a tremendous evolution in the stroke systems of care in the USA. Public awareness, prehospital care, and in-hospital protocols have never been so effectively connected. However, given the critical role of time to effective reperfusion in the setting of acute ischemic stroke, it is vital and timely to implement strategies to further streamline emergency stroke care. This article reviews the most current standards and guidelines related to the flow of stroke care in the prehospital and emergency settings.
Literature
1.
2.
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–7.
3.
Adeoye O et al. Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke. 2011;42(7):1952–5.PubMedCrossRefPubMedCentral
4.
Fassbender K et al. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013;12(6):585–96.PubMedCrossRef
5.
6.
Katzan IL et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol. 2004;61(3):346–50.PubMedCrossRef
7.
8.
Menon SC, Pandey DK, Morgenstern LB. Critical factors determining access to acute stroke care. Neurology. 1998;51(2):427–32.PubMedCrossRef
9.
Lacy CR et al. Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke. 2001;32(1):63–9.PubMedCrossRef
10.
Agyeman O et al. Time to admission in acute ischemic stroke and transient ischemic attack. Stroke. 2006;37(4):963–6.PubMedCrossRef
11.
Jurkowski JM et al. Awareness of necessity to call 9-1-1 for stroke symptoms, upstate New York. Prev Chronic Dis. 2008;5(2):A41.PubMedPubMedCentral
12.
Mosley I et al. Stroke symptoms and the decision to call for an ambulance. Stroke. 2007;38(2):361–6.PubMedCrossRef
13.
Mohammad YM. Mode of arrival to the emergency department of stroke patients in the United States. J Vasc Interv Neurol. 2008;1(3):83–6.PubMedPubMedCentral
14.
15.
16.
17.
Lecouturier J et al. Systematic review of mass media interventions designed to improve public recognition of stroke symptoms, emergency response and early treatment. BMC Public Health. 2010;10:784.PubMedCrossRefPubMedCentral
18.
Addo J et al. Delay in presentation after an acute stroke in a multiethnic population in south London: the South London Stroke Register. J Am Heart Assoc. 2012;1(3):e001685.PubMedCrossRefPubMedCentral
19.
20.
21.
Kothari R et al. Frequency and accuracy of prehospital diagnosis of acute stroke. Stroke. 1995;26(6):937–41.PubMedCrossRef
22.
23.
Jones SP et al. The identification of acute stroke: an analysis of emergency calls. Int J Stroke. 2013;8(6):408–12.PubMedCrossRef
24.
Ramanujam P et al. Accuracy of stroke recognition by emergency medical dispatchers and paramedics—San Diego experience. Prehosp Emerg Care. 2008;12(3):307–13.PubMedCrossRef
25.
De Luca A, Giorgi Rossi P, Villa GF. The use of Cincinnati Prehospital Stroke Scale during telephone dispatch interview increases the accuracy in identifying stroke and transient ischemic attack symptoms. BMC Health Serv Res. 2013;13:513.PubMedCrossRefPubMedCentral
26.••
Jauch EC et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947. This article provides the latest guidelines for early treatment of stroke patients.PubMedCrossRef
27.
Acker 3rd JE et al. Implementation strategies for emergency medical services within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council. Stroke. 2007;38(11):3097–115.PubMedCrossRef
28.
Shaw L et al. Paramedic Initiated Lisinopril for Acute Stroke Treatment (PIL-FAST): study protocol for a pilot randomised controlled trial. Trials. 2011;12:152.PubMedCrossRefPubMedCentral
29.
Nurmi J et al. Strict glucose control after acute stroke can be provided in the prehospital setting. Acad Emerg Med. 2011;18(4):436–9.PubMedCrossRef
30.
Saver JL et al. Methodology of the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial: part 2 - prehospital study methods. Int J Stroke. 2014;9(2):220–5.PubMedCrossRef
31.•
American Heart Association. Ambulance magnesium treatment fails to improve stroke outcome. 2014. This was the first clinical trial to show that administration of a stroke treatment by EMS is feasible.
32.
Ebinger M et al. Prehospital thrombolysis: a manual from Berlin. J Vis Exp. 2013;81:e50534.PubMed
33.
34.
Albright KC et al. ACCESS: acute cerebrovascular care in emergency stroke systems. Arch Neurol. 2010;67(10):1210–8.PubMedCrossRef
35.
Alberts MJ et al. Formation and function of acute stroke-ready hospitals within a stroke system of care recommendations from the brain attack coalition. Stroke. 2013;44(12):3382–93.PubMedCrossRef
36.
37.
Alberts MJ et al. Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition. Stroke. 2011;42(9):2651–65.PubMedCrossRef
38.
Schwamm LH et al. Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke. 2009;40(7):2635–60.PubMedCrossRef
39.
40.
Rubin MN, Demaerschalk BM. The use of telemedicine in the management of acute stroke. Neurosurg Focus. 2014;36(1):E4.PubMedCrossRef
41.
Pervez MA et al. Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke. 2010;41(1):e18–24.PubMedCrossRefPubMedCentral
42.
Foley N, Salter K, Teasell R. Specialized stroke services: a meta-analysis comparing three models of care. Cerebrovasc Dis. 2007;23(2–3):194–202.PubMedCrossRef
43.
Langhorne P et al. Estimating the impact of stroke unit care in a whole population: an epidemiological study using routine data. J Neurol Neurosurg Psychiatry. 2010;81(12):1301–5.PubMedCrossRef
44.••
Meretoja A et al. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79(4):306–13. This article provides a guide by use of which hospital delays in administration of intravenous thrombolysis can be reduced considerably.PubMedCrossRef
45.
Meretoja A et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology. 2013;81(12):1071–6.PubMedCrossRef
46.
Ruff IM et al. Improving door-to-needle times: a single center validation of the target stroke hypothesis. Stroke. 2014;45(2):504–8.PubMedCrossRef
47.
Schwamm LH et al. Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at get with the guidelines-stroke hospitals. Circ Cardiovasc Qual Outcomes. 2013;6(5):543–9.PubMedCrossRef
48.
Furlan A et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999;282(21):2003–11.PubMedCrossRef
49.
Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol. 2006;27(6):1177–82.PubMed
50.
Albers GW et al. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study. Ann Neurol. 2006;60(5):508–17.PubMedCrossRef
51.
52.
Jovin TG et al. Imaging-based endovascular therapy for acute ischemic stroke due to proximal intracranial anterior circulation occlusion treated beyond 8 h from time last seen well: retrospective multicenter analysis of 237 consecutive patients. Stroke. 2011;42(8):2206–11.PubMedCrossRef
53.
Haussen DC, Yavagal DR. Endovascular therapies in acute ischemic stroke. Semin Neurol. 2013;33(5):441–7.PubMedCrossRef
54.
Lansberg MG et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012;11(10):860–7.PubMedCrossRefPubMedCentral
55.
Sheth KN et al. Advanced modality imaging evaluation in acute ischemic stroke may lead to delayed endovascular reperfusion therapy without improvement in clinical outcomes. J Neurointerv Surg. 2013;5 Suppl 1:i62–5.PubMedCrossRefPubMedCentral
56.
Yoo AJ et al. Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy. Stroke. 2014;45(3):746–51.PubMedCrossRef
57.
58.
59.
60.
Turk AS et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2014;6(4):260–4.PubMedCrossRef
61.
Khatri P et al. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol. 2014;13:567–74.PubMedCrossRef
Metadata
Title
Strategies for Streamlining Emergency Stroke Care
Authors
Keith G. DeSousa
Diogo C. Haussen
Dileep R. Yavagal
Publication date
01-11-2014
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 11/2014
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-014-0497-x

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