In our single-centre study of thoracic epidural analgesia, serious adverse events occurred in 0.1% cases (1 : 1000), whereas long-term outcome was compromised in 0.014% (1.4 : 10 000) which is similar to the serious adverse event rates and outcomes reported in the current literature.
Die Akutbehandlung des Hirnschlags hat enorme Fortschritte gemacht. Um die Therapie ohne Zeitverlust durchführen zu können, muss die Organisation der Vorspitalphase angepasst werden. Entsprechend hat die Schweizerische Hirnschlag Gesellschaft mit ihren Partnergesellschaften diese Guideline erarbeitet. Die Artikel in der Rubrik «Richtlinien» geben nicht unbedingt die Ansicht der SMF-Redaktion wieder. Die Inhalte unterstehen der redaktionellen Verantwortung der unterzeichnenden Fachgesellschaft bzw. Arbeitsgruppe. Die hier vorliegende Leitlinie wurde von der Schweizerischen Hirnschlag Gesellschaft, der Schweizerischen Gesellschaft für Notfall-und Rettungsmedizin, der Schweizerischen Neurologischen Gesellschaft, der Vereinigung Rettungssanitäter Schweiz und vom Interverband für Rettungswesen miterarbeitet und gutgeheissen.
Acute stroke treatment has advanced substantially over the last years. Important milestones constitute intravenous thrombolysis, endovascular therapy (EVT), and treatment of stroke patients in dedicated units (stroke units). At present in Switzerland there are 13 certified stroke units and 10 certified EVT-capable stroke centers. Emerging challenges for the prehospital pathways are that (i) acute stroke treatment remains very time sensitive, (ii) the time window for acute stroke treatment has opened up to 24 h in selected cases, and (iii) EVT is only available in stroke centers. The goal of the current guideline is to standardize the prehospital phase of patients with acute stroke for them to receive the optimal treatment without unnecessary delays. Different prehospital models exist. For patients with large vessel occlusion (LVO), the Drip and Ship model is the most commonly used in Switzerland. This model is challenged by the Mothership model where stroke patients with suspected LVO are directly transferred to the stroke center. This latter model is only effective if there is an accurate triage by paramedics, hence the patient may benefit from the right treatment in the right place, without loss of time. Although the Cincinnati Prehospital Stroke Scale is a well-established scale to detect acute stroke in the prehospital setting, it neglects nonmotor symptoms like visual impairment or severe vertigo. Therefore we suggest “acute occurrence of a focal neurological deficit” as the trigger to enter the acute stroke pathway. For the triage whether a patient has a LVO (yes/no), there are a number of scores published. Accuracy of these scores is borderline. Nevertheless, applying the Rapid Arterial Occlusion Evaluation score or a comparable score to recognize patients with LVO may help to speed up and triage prehospital pathways. Ultimately, the decision of which model to use in which stroke network will depend on local (e.g. geographical) characteristics.
Le traitement aigu de l'accident vasculaire cérébral a fait d'énormes progrès. Afin de pouvoir assurer la prise en charge sans perdre de temps, l'organisation de la phase préhospitalière doit être adaptée. Par conséquent, la Société Cérébrovasculaire Suisse a élaboré les présentes recommandations avec ses sociétés partenaires.Les articles de la rubrique «Recommandations» ne reflètent pas
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