Stroke: How can “time is brain” be translated into clinical practice?

4 januari 2016

Ragoschke-Schumm A

BACKGROUND:

Mechanical recanalization of proximal arteries of the cerebral arterial circle with stent retrievers provides new therapeutic options for patients with ischemic stroke, in addition to the established method of intravenous (i. v.) thrombolysis; however, as with thrombolysis, the success of these measures is time-dependent. A variety of factors can delay the onset of adequate therapy and thus lead to impaired functional outcome.

OBJECTIVES:

A review of the current literature on time management in the prehospital and in-hospital phases was carried out and the most important practice-relevant measures for a rapid onset of therapy are presented.

MATERIAL AND METHODS:

A PubMed search and presentation of representative articles on the topic of time management in the therapy of acute ischemic stroke.

RESULTS:

After alerting emergency medical rescue services, professional assistants have an influence on the optimization of therapy times. Useful steps are advance notification of the hospital for admission by the emergency services, a stroke team that collects the patient directly on arrival at hospital, transfer to a reserved computed tomography (CT) or magnetic resonance imaging (MRI) scanner, a point-of-care laboratory, close proximity to an angiography suite for CT/MRI and clearly formulated standard procedures for anesthesia.

DISCUSSION:

Measures to optimize therapy times are mostly organizational and cause little or no extra costs. When implemented these measures can lead to a significant improvement in therapy times and functional patient outcome.

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