Prehospital stroke notification and endovascular therapy for large vessel occlusion: a retrospective cohort study

 But even that is nowhere near fast enough is it?

In this research in mice the needed time frame for tPA delivery is 3 minutes.

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 

But you still don't know how fast tPA has to be delivered to get 100% recovery. I bet it is in the ambulance, prior to hospital. So you don't even have the correct goal.  And to do that you'll need to implement one of these fast diagnosis items.

If you don't know how fast you have to deliver tPA to get 100% recovery you don't know a damn thing about stroke.

• fast diagnosis (66 posts)

The latest here:

Prehospital stroke notification and endovascular therapy for large vessel occlusion: a retrospective cohort study

• Satoru Fujiwara,
• Takehito Kuroda,
• Yoshinori Matsuoka,
• Nobuyuki Ohara,
• Hirotoshi Imamura,
• Yosuke Yamamoto,
• Koichi Ariyoshi,
• Nobuo Kohara,
• Michi Kawamoto &
• Nobuyuki Sakai 

Scientific Reports volume 12, Article number: 10107 (2022) Cite this article

• Metrics details

Abstract

The impact of prehospital notification by emergency medical services (EMS) on outcomes of endovascular therapy (EVT) for large vessel occlusion (LVO) remains unclear. We therefore explored the association between prehospital notification and clinical outcomes after EVT. In this single-center retrospective study from 2016 through 2020, we identified all LVO patients who received EVT. Based on the EMS’s usage of a prehospital stroke notification system, we categorized patients into two groups, Hotline and Non-hotline. The primary outcome was good neurological outcome at 90 days; other time metrics were also evaluated. Of all 312 LVO patients, the proportion of good neurological outcomes was 94/218 (43.1%) in the Hotline group and 8/34 (23.5%) in the Non-hotline group (adjusted odds ratio 2.86; 95% confidence interval 1.12 to 7.33). Time from hospital arrival to both tissue plasminogen activator and to groin puncture were shorter in the Hotline group (30 (24 to 38) min vs 48(37 to 65) min, p < 0.001; 40 (32 to 54) min vs 76 (50 to 97) min, p < 0.001), respectively. In conclusion, prehospital notification was associated with a reduction in time from hospital arrival to intervention and improved clinical outcomes in LVO patients treated with EVT.

Introduction

In the era of endovascular therapy (EVT) and tissue plasminogen activator (t-PA) for stroke patients with large vessel occlusion (LVO), the time from onset to treatment has become more critical than ever. These interventions are essentially time-sensitive^1,2,3,4, and so every health care provider should pay great attention to this factor. The chain of care for stroke begins in the prehospital setting⁵, and therefore to shorten the time taken, the role of emergency medical services (EMS) has been increasing recently. EMS providers need to suspect the possibility of stroke appropriately at the scene and transport patients as quickly as possible to appropriate hospitals, such as those with EVT-capable facilities. Furthermore, prehospital notification by EMS is recommended by the American Heart Association guidelines, as it is considered to shorten the time after arrival at hospital to treatment⁶. Thus, seamless treatment from the prehospital to the in-hospital setting is key to improving clinical outcomes in stroke patients with LVO.

Several studies have already reported the usefulness of prehospital notification by EMS to receiving hospitals both in reducing the time from hospital arrival to t-PA therapy, and also in improving rates of administration of t-PA^7,8,9. These goals are considered achievable,(Really you think 3 minutes is achievable?) as prenotification by EMS allows medical staff to prepare imaging devices such as computed tomography, or activate the hospital’s stroke team before the patient’s arrival¹⁰. Although these recent studies tried to evaluate the effect of prehospital notification on patient’s clinical outcomes, they did not succeed in actually proving the point. Further, there has been little evidence regarding stroke patients with LVO who are treated with EVT, not with t-PA alone. Additionally, the characteristics of LVO patients, without the EMS having suspected stroke, must be helpful in refining prehospital stoke management, but there has been insufficient data on the clinical characteristics, frequency and outcomes of these patients.

The present study aimed to examine the association between prehospital notification by EMS and both clinical outcomes of LVO patients and time metrics, and, additionally, to describe the characteristics of LVO patients transported without suspicion of stroke.

More at link.