Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, February 26, 2017

Receiving a clot-buster drug before reaching the hospital may reduce stroke disability

And yet they don't discuss options that don't require a scanner in the ambulance or a neurologist.

Portable brain-scanning helmet could be future for rapid brain injury assessments



http://www.alphagalileo.org/ViewItem.aspx?ItemId=172593&CultureCode=en
American Stroke Association Meeting Report – Session A17 – Abstract 119 A preliminary study shows that giving a clot-busting drug in a mobile stroke unit ambulance may lead to less disability after stroke, compared to when the clot-buster is given after reaching the hospital. The study suggests that ambulances with the personnel and equipment capable of diagnosing ischemic stroke may be worth the extra cost, due to the decrease in patient disability afterward.
Stroke patients receiving clot-busting medications before arriving at the hospital have a lower risk for disability afterward, according to research presented at the American Stroke Association’s International Stroke Conference 2017.
Researchers analyzed results from 658 stroke patients who were treated with tPA – a drug that dissolves blood clots. About half of the participants received the clot-busting drug at the hospital, and half received it while still in the ambulance.
This preliminary study showed that three months after stroke, 182 out of every 1,000 patients treated before arriving at hospital were less disabled, including 58 patients who had zero disability, compared to people who received treatment after reaching the hospital.
“Time is brain in acute stroke after vascular collaterals fail, and faster treatment yields better outcomes,” said May Nour, M.D., Ph.D., lead researcher, interventional neurologist and director of UCLA’s Mobile Stroke Rescue Program. “Our study shows pre-hospital clot-busting is a promising, evolving approach to providing tPA stroke therapy. Its better outcomes could offset the increased costs of a mobile stroke unit.”
Past research showed the sooner that a clot-busting tPA drug is given after an ischemic stroke – one in which a clot is blocking blood flow – the better patients fare. But tPA is not indicated and could hurt a patient’s chances if they are having a hemorrhagic stroke, in which a blood vessel ruptures. That is why patients need a CT scan to confirm the type of stroke before receiving tPA.
Every second counts, in the current standard of care, patients who experience stroke-like symptoms and call 9-1-1 arriving to the hospital by ambulance are assessed by clinical examination and imaging (CT or MRI scan) in the Emergency Department. This takes a certain amount of time from the patient’s symptom onset which prompted the 9-1-1 call.
In a mobile stroke unit, a specialized ambulance is equipped with a CT scanner, a paramedic, a critical care nurse, a CT technologist and a neurologist in person or by telemedicine. The ambulance arrives, does the CT on-site, gives the clot-busting drug if indicated and then transports the patient to the hospital.
Nour’s team used data from Berlin’s PHANTOM-S study, which took place from 2011 to 2015 and included 427 participants (median age 72) which were compared to 505 patients who received conventional care with in-hospital clot busting. Researchers analyzed information about patients’ disabilities to determine how many needed to be treated in the mobile stroke unit to yield a greater benefit in disability outcomes when compared to patients who received tPA at the hospital.
The findings bordered on statistical significance, suggesting that future clinical trials with a greater number of patients are needed to show similar benefits.
“People should know the warning signs of stroke and call 9-1-1 as soon as they observe stroke signs,” said Nour. “Treatment then needs to happen as quickly as possible, and a mobile stroke unit may allow that to happen.”
Coauthors include Sidney Starkman, M.D.; Latisha Sharma, M.D.; and Jeffrey Saver, M.D.
Author disclosures are on the abstract.
The study was funded by the Arline and Henry Gluck Foundation.
http://newsroom.heart.org/news/receiving-a-clot-buster-drug-before-reaching-the-hospital-may-reduce-stroke-disability?preview=8d90e8b7365e02f82394741cf20abd4c
Full bibliographic informationSession A17 -- Abstract 119
Magnitude of Benefit of Prehospital Mobile Stroke Unit vs Conventional ED Thrombolysis: Preliminary Estimate Based on PHANTOM-S Observational Registry Study
Author Block
May Nour, Sidney Starkman, Latisha K. Sharma, Jeffrey L. Saver, Univ of California, Los Angeles, Los Angeles, CA

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