Adherence to guidelines by emergency medical services during transport of stroke patients receiving intravenous thrombolytic infusion

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Ganesh AsaithambiAdnan I Qureshi

Abstract

The "drip and ship" paradigm among acute ischemic stroke (AIS) patients has resulted in expansion of thrombolytic treatment in patients eligible for intravenous (IV) recombinant tissue plasminogen activator (rt-PA). It remains controversial whether the settings within the emergency medical services (EMS) transport are adequate for IV rt-PA infusion. We sought to determine EMS adherence to guidelines during the transport of drip and ship AIS patients treated with IV rt-PA while being transferred to comprehensive stroke centers (CSCs) and the effect of nonadherence on outcome upon discharge. A retrospective evaluation of patients transferred to our CSC was conducted to determine the rates of adherence to quality parameters during EMS transport with infusion of IV rt-PA. Favorable outcome was defined as modified Rankin Scale (mRS) score ≤ 1 upon discharge. Among the 40 patients studied (55% men; mean age 71.9 ± 13.9 years), 38 patients received vital sign monitoring at 10- to 20-minute intervals. The mean transit time was 37.7 ± 20.2 minutes. Of the 39 patients with blood pressure (BP) monitoring, 7 patients had at least 1 episode of BP elevation above the recommended parameters (>180/105 mm Hg); only 1 of those was treated with a...Continue Reading

References

Mar 8, 2003·Stroke; a Journal of Cerebral Circulation·Scott L SillimanJosé G Merino
Mar 8, 2003·Stroke; a Journal of Cerebral Circulation·Irene L KatzanUNKNOWN Cleveland Clinic Health System Stroke Quality Improvement Team
May 6, 2003·Stroke; a Journal of Cerebral Circulation·Marilyn M RymerUNKNOWN America Brain and Stroke Institute Stroke Team
Sep 29, 2007·Stroke; a Journal of Cerebral Circulation·Joe E AckerUNKNOWN American Stroke Association Expert Panel on Emergency Medical Services Systems, Stroke Council
Apr 30, 2011·Stroke; a Journal of Cerebral Circulation·Lars KellertPeter A Ringleb
Jun 3, 2011·The New England Journal of Medicine·Lawrence R Wechsler

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Citations

Aug 3, 2016·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Man-Seok ParkJay Chol Choi
Feb 13, 2015·Stroke; a Journal of Cerebral Circulation·Kevin N ShethLee H Schwamm

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