BACKGROUND AND PURPOSE: Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of < or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe. METHODS: The expedited protocol includes: Benchmark onset-to-treatment within 2 hours; in-person triage of all code stroke patients; unmixed tissue plasminogen activator at the bedside during evaluation; no delays pending coagulation tests, chest x-ray, or stool guiac unless specifically indicated; and no delays pending formal CT interpretation or written consent. RESULTS: Between July 2003 and June 2005, we evaluated 781 patients and treated 103 of 781 (13.2%) with intravenous recombinant tissue plasminogen activator within 3 hours. Of these, we treated 49 of 103 (47.6%) within 2 hours of symptom onset, and 54 of 103 (52.4%) between 2 and 3 hours. The overall risk of symptomatic intracerebral hemorrhage was 4 of 103 (3.9%; 95% CI, 1.1%, 9.6%), and not significantly different from 6.4% (P=0.42). The hemorrhage risks in those treated within 2 hours of symptom onset and those treated between 2 and 3 hours were not significantly different from each other or from 6.4%. CONCLUSIONS: The expedited code stroke protocol is feasible and appears safe. Further study is warranted to confirm its safety and determine whether it results in better clinical outcomes.
BACKGROUND AND PURPOSE:Stroke recovery critically depends on timely reperfusion. In July 2003, we set a benchmark onset-to-treatment time of < or =2 hours and instituted an expedited code stroke protocol to accomplish this. We aim to show that the protocol is feasible and safe. METHODS: The expedited protocol includes: Benchmark onset-to-treatment within 2 hours; in-person triage of all code strokepatients; unmixed tissue plasminogen activator at the bedside during evaluation; no delays pending coagulation tests, chest x-ray, or stool guiac unless specifically indicated; and no delays pending formal CT interpretation or written consent. RESULTS: Between July 2003 and June 2005, we evaluated 781 patients and treated 103 of 781 (13.2%) with intravenous recombinant tissue plasminogen activator within 3 hours. Of these, we treated 49 of 103 (47.6%) within 2 hours of symptom onset, and 54 of 103 (52.4%) between 2 and 3 hours. The overall risk of symptomatic intracerebral hemorrhage was 4 of 103 (3.9%; 95% CI, 1.1%, 9.6%), and not significantly different from 6.4% (P=0.42). The hemorrhage risks in those treated within 2 hours of symptom onset and those treated between 2 and 3 hours were not significantly different from each other or from 6.4%. CONCLUSIONS: The expedited code stroke protocol is feasible and appears safe. Further study is warranted to confirm its safety and determine whether it results in better clinical outcomes.
Authors: Karen C Albright; Rema Raman; Karin Ernstrom; Hen Hallevi; Sheryl Martin-Schild; Brett C Meyer; Dawn M Meyer; Miriam M Morales; James C Grotta; Patrick D Lyden; Sean I Savitz Journal: Cerebrovasc Dis Date: 2008-11-28 Impact factor: 2.762
Authors: Sanne M Zinkstok; Ludo F Beenen; Jan S Luitse; Charles B Majoie; Paul J Nederkoorn; Yvo B Roos Journal: PLoS One Date: 2016-11-18 Impact factor: 3.240
Authors: Scott L Zuckerman; Jordan A Magarik; Kiersten B Espaillat; Nishant Ganesh Kumar; Ritwik Bhatia; Michael C Dewan; Peter J Morone; Lisa D Hermann; Anne E O'Duffy; Derek A Riebau; Howard S Kirshner; J Mocco Journal: Surg Neurol Int Date: 2016-12-21