But have you gotten tPA delivered in 3 minutes? Door-to-puncture time is an invalid measurement. You're going to have to deliver tPA in the ambulance. CAN YOU DO THAT?
In this research in mice the needed time frame for tPA delivery is 3 minutes. That's for full recovery NOT the intermediate step of reperfusion. If your hospital is touting reperfusion you don't have a functioning stroke hospital.
Electrical 'storms' and 'flash floods' drown the brain after a stroke
The latest here:
Reduction in Door-to-Groin Puncture Time for Endovascular Treatment in Acute Ischemic Stroke Patients With Large Vessel Occlusion
Abstract
Background
The outcome of mechanical thrombectomy for large vessel occlusion (LVO) in patients with acute ischemic stroke (AIS) is time-dependent. In the current stroke workflow, the pre-hospital delay is one of the most common reasons for an increase in door-to-groin puncture time (DGPT). In the present study, we sought to compare the difference in (DGPT) before and after the implementation of the Ventura Emergent Large Vessel Occlusion Score (VES) protocol for LVO.
Methods
VES was implemented in the Ventura County of California by Emergency Medical Services (EMS). We performed a retrospective analysis to compare DGPT of patients undergoing endovascular treatment (EVT) pre- and post-VES implementation. Mean and standard deviation was reported for the continuous variable ‘time for intra-arterial (IA) treatment’ in minutes. The Mann-Whitney test was used for the comparison of the variable between the two groups. analyses were performed using SAS v9.4 (SAS Institute Inc., Cary, NC) with a significant p-value of ≤0.05.
Results
A total of 304 (males: 142 and females: 162) patients were alerted of the stroke code by the EMS. VES was positive in 139 patients. Of these, 64 (46%) were males and 75 (54%) were females. VES score of 1, 2, 3, and 4 were recorded in 57 (41%), 44 (31.6%), 31 (22.3%), and 7 (5%) patients, respectively. A total of 48 VES-positive patients underwent EVT. There were 62 patients who underwent EVT before the implementation of the VES protocol. The mean DGPT for the EVT among post-VES patients was 65 minutes, which was significantly (p=0.0009) shorter than the mean DGPT of 109 minutes among pre-VES patients.
Conclusion
VES is a simplified and effective tool for identifying LVO in the field. Implementation of VES showed significantly reduced DGPT in LVO patients.
Introduction
Acute ischemic stroke (AIS) is one of the leading causes of death and long-term disability [1,2]. Large vessel occlusion (LVO) strokes represent 30-40% of all cases, resulting in approximately 90% of stroke-related morbidity and mortality [2]. Stroke treatment is time sensitive and depends on swift reperfusion of the ischemic brain tissue. Treatment of AIS-LVO involves both intravenous tissue plasminogen activator (IV-tPA) and endovascular treatment (EVT). Both treatments decrease functional disability when given early after symptom onset, however, their effectiveness drops dramatically with time [1,3,4]. Where IV-tPA is effective in the first 4.5 hours, mechanical thrombectomy (MT) is proven to be beneficial up to 24 hours from the symptom onset [3,4].
Stroke care is facilitated through coordinated systems encompassing prehospital identification and a regionalized network of hospitals to provide rapid diagnosis, triage, and treatment [5]. In the current stroke model, patients are directed to the nearest community centers, evaluated, and then transferred to an EVT-capable center for suspected or confirmed LVO [5,6]. Recently, there has been a focus on early identification and reducing stroke time metrics to facilitate timely treatment. Of these, door-to-groin puncture time (DGPT) has a significant impact on the functional outcomes [7]. DGPT for interhospital transfer patients is significantly shorter than for patients who arrive by direct transfer through emergency medical services (EMS) because of early identification and notification from the transferring facilities [8]. The major impediment at the pre-hospital level is due to delayed identification of LVO, advanced notifications, and transportation to the Comprehensive Stroke Center (CSC) [9,10].
Several pre-hospital stroke scales have been developed to identify LVO-AIS in the field by the emergency medical services (EMS) [11-16]. While these scales have variable sensitivity and specificity, they can decrease uncertainty in risk-stratifying patients for LVO and augment triage decision-making. Recently a simplified tool, Ventura Emergent Large Vessel Occlusion Score (VES) was introduced to identify LVO in the field. VES is being used by EMS of Ventura County in California, USA, to assess stroke patients for LVO as part of pre-hospital assessment [17]. In the current study, we reviewed the impact of the VES scale and LVO triage in the field on the DGPT. The purpose of our study is to compare the difference in DGPT before and after the implementation of the VES protocol. The study data was presented and published at the American Academy of Neurology (AAN) annual meeting 2021.
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