Article Data

  • Views 1207
  • Dowloads 190

Case Reports

Open Access Special Issue

Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre

  • Markku Grönroos1
  • Ville Hällberg1
  • Tuukka Tomminen1
  • Ari Palomäki1,2

1Kanta-Häme Central Hospital, Department of Emergency Medicine, Ahvenistontie 20, FI-13530 Hämeenlinna, Finland

2Tampere University, Faculty of Medicine and Health Technology, FI-33014 Tampere University, Finland

DOI: 10.22514/sv.2021.039 Vol.17,Issue 3,May 2021 pp.242-245

Submitted: 15 December 2020 Accepted: 19 January 2021

Published: 08 May 2021

*Corresponding Author(s): Markku Grönroos E-mail: markku.gronroos@khshp.fi

Abstract

COVID-19 epidemic has had a negative effect on the resources of emergency departments. While the number of acute ischaemic stroke (AIS) patients eligible for reperfusion therapies has decreased in the emergency departments (EDs), times to thrombolytic and endovascular treatments of AIS patients have become longer. In this paper, we report an ultra-fast diagnostic protocol in the settings of AIS in the ED of a primary stroke centre. Experiences using case studies of three patients have also been provided. Patients treated in accordance with the protocol received primary diagnoses and endovascular treatment with door-in-door-out times of 15 to 21 minutes.


Keywords

Acute ischemic stroke; Tissue plasminogen activator; Endovascular treatment; Door-in-door-out-time


Cite and Share

Markku Grönroos,Ville Hällberg,Tuukka Tomminen,Ari Palomäki. Short door-in-door-out time of stroke patients in need of thrombectomy in a primary stroke centre. Signa Vitae. 2021. 17(3);242-245.

References

[1] Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, 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.

[2] Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. The Lancet. 2014; 384: 1929-1935.

[3] Sarraj A, Sangha N, Hussain MS, Wisco D, Vora N, Elijovich L, et al. Endovascular therapy for acute ischemic stroke with occlusion of the middle cerebral artery M2 segment. JAMA Neurology. 2016; 73: 1291-1296.

[4] Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. The Lancet Neurology. 2018; 17: 895-904.

[5] Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. Journal of the American Medical Association. 2016; 316: 1279-1288.

[6] Naskali J, Palomaki A, Harjola VP, Hallberg V, Rautava VP, Innamaa T. Emergency medicine in Finland: first year experiences of specialist training. Journal of Academic Emergency Medicine. 2014; 13: 26-29.

[7] Heikkilä I, Kuusisto H, Stolberg A, Palomäki A. Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2016; 24: 46.

[8] Heikkilä I, Kuusisto H, Holmberg M, Palomäki A. Fast protocol for treating acute ischemic stroke by emergency physicians. Annals of Emergency Medicine. 2019; 73: 105-112.

[9] Distante C, Piscitelli P, Miani A. COVID-19 outbreak progression in Italian regions: approaching the peak by the end of March in northern Italy and first week of April in southern Italy. International Journal of Environmental Research and Public Health. 2020; 17: 3025.

[10] Alquézar-Arbé A, Piñera P, Jacob J, Martín A, Jiménez S, Llorens P, et al. Impact of the COVID-19 pandemic on hospital emergency departments: results of a survey of departments in 2020-the Spanish ENCOVUR study. Emergencias. 2020; 32: 320-331.

[11] Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurology. 2020; 77: 683.

[12] Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. The Lancet Neurology. 2020; 19: 767-783.

[13] Tejada Meza H, Lambea Gil Á, Sancho Saldaña A, Martínez-Zabaleta M, Garmendia Lopetegui E, López-Cancio Martínez E, et al. Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain. European Journal of Neurology. 2020; 27: 2491-2498.

[14] Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, et al. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. Journal of Neurology. 2020. doi: 10.1007/s00415-020-10199-6 (online ahead of print).

[15] Bhaskar S, Sharma D, Walker AH, McDonald M, Huasen B, Haridas A, et al. Acute neurological care in the COVID-19 era: the pandemic health system REsilience PROGRAM (REPROGRAM) consortium pathway. Frontiers in Neurology. 2020; 11: 579.

[16] Ruotsalainen P, Iivari A, Doupi P. Finland’s strategy and implementation of citizens’ access to health information. Studies in Health Technology and Informatics. 2008; 137: 379-385.

[17] McTaggart RA, Moldovan K, Oliver LA, Dibiasio EL, Baird GL, Hemendinger ML, et al. Door-in-door-out time at primary stroke centers may predict outcome for emergent large vessel occlusion patients. Stroke. 2018; 49: 2969-2974.

[18] Choi PMC, Tsoi AH, Pope AL, Leung S, Frost T, Loh P, et al. Door-in-door-out time of 60 minutes for stroke with emergent large vessel occlusion at a primary stroke center. Stroke. 2019; 50: 2829-2834.

[19] Tiu J, Watson T, Clissold B. Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis. Internal Medicine Journal. 2020. doi: 101111/imj.14843 (online ahead of print).

[20] Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, et al. Hypercoagulability of COVID-19 patients in intensive care unit: a report of thromboelastography findings and other parameters of hemostasis. Journal of Thrombosis and Haemostasis. 2020; 18: 1738-1742.

[21] Ranucci M, Ballotta A, Di Dedda U, Bayshnikova E, Dei Poli M, Resta M, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. Journal of Thrombosis and Haemostasis. 2020; 18: 1747-1751.

[22] Maier CL, Truong AD, Auld SC, Polly DM, Tanksley C, Duncan A. COVID-19-associated hyperviscosity: a link between inflammation and thrombophilia? The Lancet. 2020; 395: 1758-1759.

[23] Santana Baskar P, Cordato D, Wardman D, Bhaskar S. In-hospital acute stroke workflow in acute stroke-systems-based approaches. Acta Neurologica Scandinavica. 2021; 143: 111-120.

[24] Gangadharan S, Lillicrap T, Miteff F, Garcia-Bermejo P, Wellings T, O’Brien B, et al. Air vs. Road decision for endovascular clot retrieval in a rural telestroke network. Frontiers in Neurology. 2020; 11: 628.

[25] Rautava V, Palomäki E, Innamaa T, Perttu M, Lehto P, Palomäki A. Improvement in self-reported confidence in nurses’ professional skills in the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013; 21: 16.

[26] Lehtonen H, Lukkarinen T, Kämäräinen V, Rautava VP, Parviainen P, Palomäki A. Improving emergency department capacity efficiency. Signa Vitae. 2016; 12: 52-57.

[27] Ojakäär A, Purdy M, Kechagias A, Järvelin U, Palomäki A. Immediate effects of urgent reorganisation of emergency department-based treat-ment pathway in nonperforated appendicitis: a retrospective study. BMC Emergency Medicine. 2020; 20: 45.

[28] Tuominen J, Hällberg V, Oksala N, Palomäki A, Lukkarinen T, Roine A. NYU-EDA in modelling the effect of COVID-19 on patient volumes in a Finnish emergency department. BMC Emergency Medicine. 2020; 20: 97.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top