Hospitals in California are administering anti-clot drugs to stroke patients twice as fast as the national average. And in the event of a stroke, minutes count.
“When a stroke happens, the minutes count,” says lead study author Mai Nguyen-Huynh. Faster treatment with treatment with intravenous r-tPA, which dissolves the clot that causes ischemic stroke and restores blood flow to the brain, is strongly associated with better functional outcomes for patients ” . A simple treatment but which should only be administered in ischemic forms and in very strict indications, hence the need for an expert opinion.
Telemedicine speeds up care
Published in Stroke magazine, this is one of the first studies to demonstrate how the successful implementation of standardized treatment protocols via telemedicine can dramatically reduce the time it takes to start much-needed stroke treatment before the maximum time to intervention. The administration time was reduced to 34 minutes compared to an average of 53 minutes and the administration time of less than 60 minutes was reached in 87% of cases compared to 61% in the normal procedure.
The American Heart Association and American Stroke Association guidelines recommend times of up to 60 minutes for intravenous r-tPA.
Every second the patient loses nerve cells
In the event of ischemic cerebrovascular accident, the emergency treatment, in a neurovascular unit or in coordination with it, consists in dissolving the clot which blocks the cerebral artery by infusing a drug: this treatment is called “thrombolysis” by the rt-PA (Recombinant Tissue-Plasminogen Activator) and is administered intravenously.
This treatment must be carried out as soon as possible, but in any case within the first 4 hours following the onset of signs of deficit when one is sure of having eliminated a hemorrhage. It will restore blood circulation and oxygen supply to the brain, and therefore limit the extent of the brain injury and its after-effects.
Thrombolysis is associated with a high risk of bleeding in the brain and digestive tract. The decision of thrombolysis must therefore be made by a doctor specializing in neurovascular pathology after evaluation of the major contraindications (severity of the stroke, size of the cerebral infarction in imaging, history, blood pressure control, etc.).
An accelerated modus operandi
Telemedicine has been incorporated into a complete reorganization of acute stroke management in Northern California. “The processes that were occurring sequentially during a suspected stroke, one after the other, are now occurring at the same time,” explains the author. This allows us to quickly, safely and confidently assess and treat intravenous r-tPA ”.
Each team member is responsible for carrying out the tasks, in tandem. Paramedics notify the emergency department that a patient with suspected stroke is on the way. A “stroke alert” alerts a neurologist, who meets the patient upon arrival, in person or by video, to coordinate the stroke alert. Pharmacists quickly prepare anti-clot medications so that they are ready to be administered as soon as a radiologist reads the brain imaging (CT scan or MRI) and then confirms that the patient does not have a hemorrhagic form of stroke .
Once it is diagnosed as a “good candidate” for intravenous r-tPA, the injection is performed, which allows it to be administered twice as fast as anywhere else in the United States, and therefore to limit the importance of stroke and its sequelae. The percentage of intracranial hemorrhage was not significantly greater with the telemedicine accelerated procedure (3.8% versus 2.2%; NS).
With a very high speed of intervention, it is even possible to have no sequelae.
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