Deans' stroke musings: Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to <30 Minutes in a Large Urban Academic Comprehensive Stroke Center

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, December 19, 2018

Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to <30 Minutes in a Large Urban Academic Comprehensive Stroke Center

Are you that fucking incompetent that you aren't trying these much faster ways to diagnose stroke? 30 minutes is appalling. I expect treatment prior to hospital arrival and that is without the mobile stroke unit with scanner capability.

We need to get to these much faster and objective diagnosis tools, but that would be a neurologist job killer which means it will never occur even if better for patients.

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes

Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to <30 Minutes in a Large Urban Academic Comprehensive Stroke Center

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Nirav Bhatt, MD, Erika T. Marulanda-Londoño, MD, Kunakorn Atchaneeyasakul, MD, ...

First Published October 3, 2018 Brief Report

Abstract

The therapeutic window for acute ischemic stroke with intravenous recombinant tissue plasminogen activator (IV rt-PA) is brief and crucial. The American Heart Association/American Stroke Association Target: Stroke Best Practice Strategies (TSBPS) aim to improve intravenous thrombolysis door-to-needle (DTN) time. We assessed the efficacy of implementation of selected TSBPS to reduce DTN time in a large tertiary care hospital. A multidisciplinary DTN committee assessed causes of delayed DTN time and implemented focused TSBPS in our urban academic medical center. We analyzed door-to-CT time, DTN time, and CT to IV rt-PA time in consecutive patients treated with IV rt-PA over 27 months preimplementation and 13 months postimplementation. One hundred forty-eight patients were included in the preimplementation and 126 in the postimplementation group. We found no significant difference between the groups in demographics, comorbidities, anticoagulation status, prethrombolysis hypertension treatment, arrival by EMS, after-hours arrival, or in stroke etiology. After implementation, median DTN time improved from 59 (interquartile range [IQR]: 52-80) to 29 (IQR: 20-41) minutes (P < .001). Door-to-CT time decreased from 17 (14-21) to 16 (12-19) minutes (P = .016), and CT-to-IV rt-PA time improved from 43 (IQR: 31-59) to 13 (IQR: 6-23) minutes (P < .001). Rates of symptomatic intracranial hemorrhage (2.7% vs 3.2%, P = .82) and treatment of stroke mimics (9% vs 13%, P = .31) were similar in both the groups. Individualized hospital gap analysis identifies targeted interventions that lead to rapid and sustained improvement in treatment times.