European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre‐hospital management of stroke

Abstract

Background and purpose: The reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. Methods:The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations. Results:Despite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a pre-hospital 'code stroke' including highest priority dispatch, pre-hospital notification and rapid transfer to the closest 'stroke-ready' centre. Insufficient evidence was found to recommend a pre-hospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for pre-hospital telemedicine during ambulance transport.Conclusions: These guidelines inform on the contemporary approach to patients with suspected stroke in the pre-hospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome.

A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke

“…The European Academy of Neurology and European Stroke Organization consensus statement for prehospital management of stroke did not support routine use of pre-hospital telemedicine for suspected stroke [104]. However, we identified evidence from observational studies and one RCT [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] of the safety, feasibility, and potential scalability of telemedicine, with equivalent diagnostic accuracy to hospital-based clinical diagnoses.…”

“…Although reported running costs were relatively low, none of the studies reported on the full range of costs required for implementation (training, unit, operating and maintenance) which would inform commissioning decisions. Nevertheless, increased efficiency with telestroke (e.g., 13 min reductions in door-to-needle time [34]) is congruent with mobile stroke units [105], which also lack clear evidence of better patient health outcomes [104]; telestroke technology could be a significantly more cost-effective alternative in systems which do not have specialists present in the ambulance [34]. In conjunction with clinician acceptability for the majority of telestroke systems, the modest goal (stratification) permits feasibility of implementing telestroke technologies in the pre-hospital setting in the near future; however, further studies are still required.…”

Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis

“…La investigación sobre el desempeño de los servicios de emergencias en el ictus, como patología dependiente del tiempo [18], es un campo de investigación operativa de gran importancia e interés, y puede centrarse en la mejora de tiempos y en la implantación efectiva de las medidas recomendadas [19]. Es llamativa la escasez de estudios publicados al respecto en nuestro país, y en ese sentido creemos que nuestra aportación cobra más valor al facilitar la comparación con otros grupos.…”

SOP Prähospitale Schlaganfallversorgung

“…Bei PatientInnen mit schweren Schlaganfallsyndromen und dadurch hoher Wahrscheinlichkeit eines größeren Gefäßverschlusses könnte es vorteilhaft sein, diese bei nur geringen Zeitverlusten (< 45 Minuten) direkt in ein Interventionszentrum zu transportieren [5]. Allerdings stehen diesbezüglich noch die Ergebnisse größerer Studien aus, daher kann derzeit noch kein präklinischer Score uneingeschränkt empfohlen werden [6].…”