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In My Opinion

Stroke and the Need for Speed

Published March 17, 2014 9:20 AM by Jimmy Thacker
Stroke is the number four killer in the United States. Faster treatment helps save lives, but faster treatment may also be quantified, thanks to a study at the University of Melbourne, Australia. Dr. Atte Meretoia discovered that for every 15 minutes quicker that treatment is received, a month can be added to the patient's life. The faster tissue plasminogin activator (tPA) is delivered, the better the outcomes. The standard 4 or 4.5 hours may not be the standard much longer, giving way to as soon as possible.
    The secret seems to be that the faster the drug is delivered, the more tissue and blood flow is restored to a nearly normal state. This means that not only elderly folks who we typically think of as stroke patients, but younger people, too, can benefit from quicker administration of tPA.
    In my opinion, we need to get on board with Australia and get tPA to our patients as quickly as possible. This is another reason why every hospital should have quick reaction teams specifically designed for the treatment of stroke and other deadly events we see in our emergency rooms. The teams can react quickly with protocols designed to improve efficiency and reaction times, giving our patients better outcomes and prognoses. The United States needs to do studies and get this standard into every emergency room in the country as soon as possible.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, MO
posted by Jimmy Thacker
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1 comments

Jimmy I don't disagree with the need for speed, but this is not news. The credo for many stroke programs/services has long been "time is brain". And the goal is not just to add months to the survivor's life, but to preserve function so they can continue to live much as they did before the event.

The 4.5 hours you mention is not the "standard", it is the window of opportunity. It is measured from the onset of stroke symptoms. Administration of tPA is not recommended beyond 4.5 hours as there is little/no evidence of benefit and the risks associated with tPA are increased. The standard is under 60 minutes from "door to drug". In that 60minutes the patient must be assessed to assure it is a stroke, and that they have no contraindication to tPA administration. Blood work and a non-contrast CT scan of the head must be performed and results available. The CT is to rule out a bleed as the cause of the stroke as that is the biggest contraindication to tPA administration.

As for getting on board there are national initiatives to improve stroke care. The Joint Commission offers disease specific certifications in a number of areas including for Primary Stroke Centers and Comprehensive Stroke Centers. This designation is separate from accreditation by TJC. The American Stroke Association (ASA), part of the American Heart Association, offers their Stroke Get With the Guidelines (GWTG) program. The guidelines in this program are evidence based best practices, such as tPA in less than 1 hour, etc. Participating centers submit their data to the GWTG database. Programs that meet certain percentages are recognized at the Bronze, Silver, Gold and Platinum levels. Some levels can only be achieved by demonstrating consistent high performance over several years. Details for these programs are available on the organizations respective websites.

ASA also is involved in public education. You may have seen billboards with the "...stroke is a brain attack" or the "FAST-face, arms, speech, and time" info. A large part in successful stroke treatment is getting the public to recognize the signs/symptoms of stroke and act FAST-getting care in under 4.5 hours. As you note sooner is better!

Thanks,

Chuck

Chuck, RT - Manager, CarolinaEast Health March 26, 2014 6:33 PM
New Bern NC

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