Chapter 18
Stroke
Timothy P. Chizmar,
Janelle M. Martin,
Timothy P. Chizmar
Search for more papers by this authorJanelle M. Martin
Search for more papers by this authorTimothy P. Chizmar,
Janelle M. Martin,
Timothy P. Chizmar
Search for more papers by this authorJanelle M. Martin
Search for more papers by this authorBook Editor(s):David C. Cone MD,
Jane H. Brice MD, MPH,
Theodore R. Delbridge MD, MPH,
J. Brent Myers MD, MPH,
David C. Cone MD
Professor of Emergency Medicine
Yale University School of Medicine, New Haven, Connecticut
Search for more papers by this authorJane H. Brice MD, MPH
Professor of Emergency Medicine
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorTheodore R. Delbridge MD, MPH
Executive Director
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland
Search for more papers by this authorJ. Brent Myers MD, MPH
Chief Medical Officer ESO Associate Medical Director
Wake County EMS, Raleigh, North Carolina
Search for more papers by this authorFirst published: 18 August 2021
Summary
Stroke is a devastating disease that is the leading cause of long-term adult disability. Patient prognosis is largely dependent on early presentation for treatment to a capable facility. The EMS system is the fundamental link in the chain of events that collectively promote earlier therapeutic care. From dispatch to emergency department arrival, the EMS system can take proactive steps to ensure rapid presentation for life-saving therapeutic interventions, which has been shown to improve patient outcomes. This chapter discusses the various tools available to EMS personnel to assist in the rapid identification and management of stroke patients. Protocols and the various treatments available at different types of facilities capable of treating stroke are also discussed.
References
- Benjamin EJ , Salim SV , Callaway CW , et al. Heart disease and stroke statistics–2018 update: a report from the American Heart Association . Circulation . 2018 ; 137 : e67 – e492 .
- Van Der Worp H , Gijn J . Clinical practice. Acute ischemic stroke . N Engl J Med . 2007 ; 357 : 572 – 9 .
- National Institute of Neurological Disorders and Stroke . Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Transient-Ischemic-Attack-Information-Page . Accessed July 30, 2020.
- Albers W , Caplan L , Easton D , et al. Transient ischemic attack–proposal for a new definition . N Engl J Med . 2002 ; 347 : 1713 – 14 .
- Reginella RL , Crocco T , Tadros A , et al. Predictors of stroke during 9-1-1 calls: opportunities for improving EMS response . Prehosp Emerg Care . 2006 ; 10 : 369 – 73 .
- Porteous GH , Corry MD , Smith W . Emergency medical services dispatcher identification of stroke and transient ischemic attacks . Prehosp Emerg Care . 1999 ; 3 : 211 – 16 .
- Handschu R , Poppe R , Rauss J , et al. Emergency calls in acute stroke . Stroke . 2003 ; 34 : 1005 – 1009 .
- Acker JE 3rd , Pancioli AM , Crocco TJ , et al. Implementation strategies for emergency medical services within stroke systems of care; a policy statement from the American Heart Association/American Stroke Association expert panel on emergency medical services systems and stroke council . Stroke . 2007 ; 38 ; 3097 – 115 .
- Jauch EC , Cucchiara B , Adeoye O , et al. Part 11: Adult stroke: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care . Circulation . 2010 ; 122 : S818 – 28 .
- Kothari RU , Pancioli A , Liu T , et al. Cincinnati prehospital stroke scale: reproducibility and validity . Ann Emerg Med . 1999 ; 33 : 373 – 7 .
- Kidwell C , Starkman S , Eckstein M , et al. Identifying stroke in the field–prospective validation of the Los Angeles prehospital stroke screen (LAPSS) . Stroke . 2000 ; 31 : 71 – 76 .
- Ribo M , Molina C , Montaner J , et al. Acute hyperglycemia state is associated with lower tPA induced recanalization rates in stroke patients . Stroke . 2005 ; 36 : 1705 – 9 .
- Millin M , Gullett T , Daya M . EMS management of acute stroke out of hospital treatment and stroke system development . Prehosp Emerg Care . 2007 ; 11 : 318 – 25 .
- Advanced Cardiovascular Life Support Provider Manual . Dallas, TX : American Heart Association , 2006 . pp 103 – 17 .
- Jauch EC , Saver JL , Adams HP Jr , et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association . Stroke . 2013 ; 44 : 870 – 947 .
- McKinney JS , Mylavarapu K , Lane J , Roberts V , Ohman-Strickland P , Merlin MA . Hospital prenotification of stroke patients by emergency medical services improves stroke time targets . J Stroke Cerebrovasc Dis . 2013 ; 22 : 113 – 18 .
- Patel MD , Rose KM , O'Brien EC , Rosamond WD . Prehospital notification by emergency medical services reduces delays in stroke evaluation: findings from the North Carolina stroke care collaborative . Stroke . 2011 ; 42 : 2263 – 8 .
- Sussman BJ , Fitch TSP . Thrombolysis with fibrinolysin in cerebral arterial occlusion; the role of angiography . Angiology . 1959 ; 10 : 268 – 82 .
- Röther J , Ford GA , Thijs VN . Thrombolytics in acute ischaemic stroke: historical perspective and future opportunities . Cerebrovasc Dis . 2013 ; 35 : 313 – 9 .
- The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group . Tissue plasminogen activator for acute ischemic stroke . N Engl J Med . 1995 ; 333 : 1581 – 7 .
- Kwiatkowski TG , Libman RB , Frankel M , et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group . N Engl J Med . 1999 ; 340 : 1781 – 7 .
- Magid D , Naviaux N , Wears R . Stroking the data: reanalysis of the NINDS trial . Ann Emerg Med . 2005 ; 45 : 385 – 7 .
- Miller J , Hartwell C , Lewandowski C . Stroke treatment using intravenous and intra-arterial tissue plasminogen activator . Curr Treat Options Cardiovasc Med . 2012 ; 14 : 273 – 83 .
- Lewandowski C , Barsan W . Treatment of acute ischemic stroke . Ann Emerg Med . 2001 ; 37 : 202 – 16 .
- Albers G , Marks M , Kemp S , et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging . N Engl J Med . 2018 ; 378 : 708 – 18 .
- Nogueira R , Jadhav A , Haussen D , et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct . N Engl J Med . 2018 ; 378 : 11 – 21 .
- Richards C , Huebinger R , Tataris K , et al. The Cincinnati Prehospital Stroke Scale can identify large vessel occlusion stroke . Prehosp Emerg Care . 2018 ; 22 : 312 – 18 .
- Dickson R , Crowe R , Patrick C , et al. Performance of the RACE Score for the prehospital identification of large vessel occlusion stroke in a suburban/rural EMS service . Prehosp Emerg Care . 2019 ; 23 ; 612 – 8 .
- Rossnagel K , Jungehülsing GJ , Nolte CH , et al. Out-of-hospital delays in patients with acute stroke . Ann Emerg Med . 2004 ; 44 : 476 – 83 .
- Maestroni A , Mandelli C , Manganaro D , et al. Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy . Emerg Med J . 2008 ; 25 : 340 – 5 .
- Wester P , Rådberg J , Lundgren B , Peltonen M . Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study . Stroke . 1999 ; 30 : 40 – 8 .
- Derex L , Adeleine P , Nighoghossian N , Honnorat J , Trouillas P . Factors influencing early admission in a French stroke unit . Stroke . 2002 ; 33 : 153 – 9 .
- California Acute Stroke Pilot Registry (CASPR) Investigators . Prioritizing interventions to improve rates of thrombolysis for ischemic stroke . Neurol . 2005 ; 64 : 654 – 9 .
- Quain DA , Parsons MW , Loudfoot AR , et al. Improving access to acute stroke therapies: a controlled trial of organised pre-hospital and emergency care . Med J Aust . 2008 ; 189 : 429 – 33 .
- Smith W , Sung G , Starkman S , et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke results of the MERCI trial . Stroke . 2005 ; 36 : 1432 – 40 .
- Joint Commission on Hospital Accreditation of Healthcare Organizations . Advanced Certification for Primary Stroke Centers . Available at: https://www.jointcommission.org/accreditation-and-certification/certification/certifications-by-setting/hospital-certifications/stroke-certification/advanced-stroke/primary-stroke-center . Accessed July 30, 2020.
- Alberts MJ , Latchaw RE , Jagoda A , et al. Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition . Stroke . 2011 ; 42 : 2651 – 65 .
- Joint Commission on Hospital Accreditation of Healthcare Organizations . The Joint Commission Stroke Certification Programs – Program Concept Comparison . https://www.jointcommission.org/-/media/tjc/documents/accred-and-cert/certification/certification-by-setting/stroke/dsc-stroke-grid-comparison-chart.pdf . Accessed August 7, 2020.
- Alberts MJ , Latchaw RE , Selman WR , et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition . Stroke . 2005 ; 36 : 1597 – 616 .
- Silliman SL , Quinn B , Huggett V , Merino JG . Use of a field-to-stroke center helicopter transport program to extend thrombolytic therapy to rural residents . Stroke . 2003 ; 34 : 729 – 33 .
- Thomas SH , Kociszewski C , Schwamm LH , Wedel SK . The evolving role of helicopter emergency medical services in the transfer of stroke patients to specialized centers . Prehosp Emerg Care . 2002 ; 6 : 210 – 14 .
- Shuaib A , Jeerakathil T , the Alberta Mobile Stroke Unit Investigators . The mobile stroke unit and management of acute stroke in rural settings . CMAJ . 2018 ; 190 : E855 – 8 .
- Kummer BR , Lerario MP , Navi BB , et al. Clinical information systems integration in New York City's first mobile stroke unit . Appl Clin Inform . 2018 ; 9 : 89 – 98 .
- Schlemm L , Endres M , Nolte C . Bypassing the closest stroke center for thrombectomy candidates: what additional delay to thrombolysis is acceptable? Stroke . 2020 ; 51 : 867 – 75 .
- Niklasson A , Herlitz J , Jood K . Socioeconomic disparities in prehospital stroke care . Scand J Trauma Resusc Emerg Med . 2019 ; 27 : 53 .
