Reducing in-hospital delay to 20 minutes in stroke thrombolysis

Meretoja, Atte; Strbian, Daniel; Mustanoja, Satu; Tatlısumak, Turgut; Lindsberg, Perttu J.; Kaste, Markku

doi:10.1212/wnl.0b013e31825d6011

Cited by 500 publications

(480 citation statements)

References 32 publications

Supporting

Mentioning

452

Contrasting

Unclassified

Order By: Relevance

“…The analysis was carried out for the remaining 379 patients, 180 with PHN and 199 without PHN (Figure 1). Median door-to-CT time for the PHN group was 6 min less than for the no-PHN group, which was statistically significant (median [interquartile range: IQR]; 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] vs 20 ; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

et al. 2018

View full text Add to dashboard Cite

Aim:To reduce in-hospital intervals by developing a prehospital notification (PHN) protocol which directly notifies a neurologist to prepare for possible treatment. Methods: A 24/7 connection was established between emergency medical services dispatch and the on-call neurologist. A database of all patients with in-hospital stroke code activation was developed, door-to-computed tomography (CT) time and door-toneedle time was recorded from January 2013 to December 2016. The statistical results were considered significant at p < 0.05. Result: PHN resulted in a significant reduction in door-to-CT time (median 14 vs 20; p < 0.001). Among patients who were treated with intravenous thrombolysis, door-to-needle time was significantly shorter in patients with PHN compared with non-PHN group (median 42 vs 70; p < 0.001). Conclusion: PHN effectively reduced door-to-CT and door-to-needle times.

show abstract

Section: Resultsmentioning

confidence: 99%

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

et al. 2018

View full text Add to dashboard Cite

show abstract

“…However, one has to keep an eye on the balance between speed to treatment and diagnostic accuracy to minimize the thrombolytic treatment of stroke mimics which is suggested to be below 3% [17,18]. Therefore, the described door-to-needle time cannot be suggested as a target time for thrombolysis, but demonstrates the potential of the Helsinki protocol under optimal circumstances [8]. Moreover, this case allows each hospital to compare door-to-needle-times under optimal circumstances.…”

Section: Discussionmentioning

confidence: 99%

A Case with 7 Min Door-To-Needle-Time and an Outline of Ultrarapid Stroke Management

Klingner¹

2015

Brain Disord Ther

View full text Add to dashboard Cite

Tissue plasminogen activator (t-PA) is the only approved thrombolytic therapy for the treatment of stroke patients. Its effectiveness is highly time dependent due to the sensitivity of brain tissue to ischemia. Therefore, it is crucial to minimize the time between the onset of symptoms and the initiation of an effective thrombolytic treatment. Here we describe a case that received an ultrarapid thrombolytic therapy. A 72-year-old woman was presented at our emergency department with a sudden occurrence of severe left sided hemiparesis. After exclusion of intracranial hemorrhage, the patient received intravenous thrombolysis therapy 7 min after arrival at our hospital. The patient showed a fast, nearly complete improvement of symptoms, and a minor infarction was detected in a follow up MRI. We describe this case and the general stroke management in our emergency department that led to this rapid doorto-needle time.

show abstract

“…The benefits of thrombolysis are time-dependent. Efficacy of thrombolytic therapy for ischemic stroke decreases with time elapsed from symptom onset 1 . Therefore, delays until initiation of treatment must be avoided.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Thrombolysis: A Manual from Berlin

Ebinger¹,

Lindenlaub²,

Kunz³

et al. 2013

JoVE

View full text Add to dashboard Cite

In acute ischemic stroke, time from symptom onset to intervention is a decisive prognostic factor. In order to reduce this time, prehospital thrombolysis at the emergency site would be preferable. However, apart from neurological expertise and laboratory investigations a computed tomography (CT) scan is necessary to exclude hemorrhagic stroke prior to thrombolysis. Therefore, a specialized ambulance equipped with a CT scanner and point-of-care laboratory was designed and constructed. Further, a new stroke identifying interview algorithm was developed and implemented in the Berlin emergency medical services. Since February 2011 the identification of suspected stroke in the dispatch center of the Berlin Fire Brigade prompts the deployment of this ambulance, a stroke emergency mobile (STEMO). On arrival, a neurologist, experienced in stroke care and with additional training in emergency medicine, takes a neurological examination. If stroke is suspected a CT scan excludes intracranial hemorrhage. The CT-scans are telemetrically transmitted to the neuroradiologist on-call. If coagulation status of the patient is normal and patient's medical history reveals no contraindication, prehospital thrombolysis is applied according to current guidelines (intravenous recombinant tissue plasminogen activator, iv rtPA, alteplase, Actilyse).Thereafter patients are transported to the nearest hospital with a certified stroke unit for further treatment and assessment of strokeaetiology. After a pilot-phase, weeks were randomized into blocks either with or without STEMO care. Primary end-point of this study is time from alarm to the initiation of thrombolysis. We hypothesized that alarm-to-treatment time can be reduced by at least 20 min compared to regular care.

show abstract

Reducing in-hospital delay to 20 minutes in stroke thrombolysis

Abstract: With multiple concurrent strategies it is possible to cut the median in-hospital delay to 20 minutes. The key is to do as little as possible after the patient has arrived at the emergency room and as much as possible before that, while the patient is being transported.

Cited by 500 publications

References 32 publications

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

A Case with 7 Min Door-To-Needle-Time and an Outline of Ultrarapid Stroke Management

Prehospital Thrombolysis: A Manual from Berlin

Contact Info

Product

Resources

About