Exclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour

ABSTRACT

The door-to-needle time is an important goal to reduce the time to treatment in intravenous thrombolysis.

Objective Analyze if the inclusion of an exclusive thrombolytic bed reduces the door-to-needle time.

Method One hundred and fifty patients admitted for neurological evaluation with ischemic stroke were separated in two groups: in the first, patients were admitted in the Emergency Room for intravenous thrombolysis (ER Group); in the second, patients were admitted in an exclusive thrombolytic bed in the general neurology ward (TB Group).

Results Sixty-eight (86.0%) patients from TB Group were treated in the first 60 minutes of arrival as compared to 48 (67.6%) in the ER Group (p = 0.011).

Conclusion The introduction of a thrombolytic bed in a general hospital setting can markedly reduce the door-to-needle time, allowing more than 85% of patients to be treated within the first hour of admission.

RESUMO

A redução no tempo porta-agulha é um objetivo importante para diminuir o tempo de tratamento na trombólise endovenosa.

Objetivo Analisar se a inclusão de um leito exclusivo de trombólise reduz o tempo porta-agulha.

Método Cento e cinqüenta pacientes admitidos com acidente vascular cerebral isquêmico foram separados em dois grupos: no primeiro, os pacientes foram admitidos no Pronto-Atendimento para trombólise endovenosa (Grupo PA); no segundo, os pacientes foram admitidos no leito de trombólise na enfermaria de neurologia (Grupo LT).

Resultados Sessenta e oito (86,0%) pacientes do Grupo LT foram tratados nos primeiros 60 minutos após a chegada, em comparação com 48 (67,6%) no Grupo PA (p = 0,011).

Conclusão A introdução de um leito de trombólise em ambiente hospitalar pode reduzir marcadamente o tempo porta-agulha, permitindo que mais de 85% dos pacientes sejam tratados na primeira hora de admissão.

neurology - stroke - treatment - thrombolytic therapy

neurologia - acidente vascular cerebral - tratamento - terapia trombolítica

• References

• 1 Meretoja A, Keshtkaran M, Saver JL, Tatlisumak T, Parsons MW, Kaste M et al.. Stroke thrombolysis: save a minute, save a day. Stroke. 2014;45(4):1053-8. doi:10.1161/STROKEAHA.113.002910
• 2 Fonarow GC, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Grau-Sepulveda MV et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation. 2011;123(7):750-8. doi:10.1161/CIRCULATIONAHA.110.974675
• 3 Lange MC, Zétola VF, Parolin MF, Zamproni LN, Fernandes AF, Piovesan EJ et al. Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city. Arq Neuropsiquiatr. 2011;69(3):441-5. doi:10.1590/S0004-282X2011000400006
• 4 Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79(4):306-13. doi:10.1212/WNL.0b013e31825d6011
• 5 Meretoja A, Weir L, Ugalde M, Yassi N, Yan B, Hand P et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology. 2013;81(12):1071-6. doi:10.1212/WNL.0b013e3182a4a4d2
• 6 Martins SC, Freitas GR, Pontes-Neto OM, Pieri A, Moro CH, Jesus PA et al. Guidelines for acute ischemic stroke treatment. Part II: stroke treatment. Arq Neuropsiquiatr. 2012;70(11):885-93. doi:10.1590/S0004-282X2012001100012
• 7 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(24):1581-7. doi:10.1056/NEJM199512143332401
• 8 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(3):870-947. doi:10.1161/STR.0b013e318284056a
• 9 Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-29. doi:10.1056/NEJMoa0804656
• 10 Fonarow GC, Zhao X, Smith EE, Saver JL, Reeves MJ, Bhatt DL et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014;311(16):1632-40. doi:10.1001/jama.2014.3203
• 11 Learmonth SR, Ireland A, McKiernan CJ, Burton P. Does initiation of an ambulance pre-alert call reduce the door to needle time in acute myocardial infarct? Emerg Med J. 2006;23(1):79-81. doi:10.1136/emj.2004.022376
• 12 Larosa JA, Ahmad N, Feinberg M, Shah M, Dibrienza R, Studer S. The use of an early alert system to improve compliance with sepsis bundles and to assess impact on mortality. Crit Care Res Pract. 2012;2012:980369.
• 13 Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma. Ann Surg. 2011;253(6):1178-83. doi:10.1155/2012/980369
• 14 Bhakta A, Bloom M, Warren H, Shah N, Casas T, Ewing T et al. The impact of implementing a 24/7 open trauma bed protocol in the surgical intensive care unit on throughput and outcomes. J Trauma Acute Care Surg. 2013;75(1):97-101. doi:10.1097/TA.0b013e31829849e5
• 15 Fernandes PT, Avelar WM, Mory SB, Hansen R, Li LM. Perception and attitude towards stroke by professionals of emergency medical service in an urban city in southeastern Brazil. J Stroke Cerebrovasc Dis. 2009;18(3):195-7. doi:10.1016/j.jstrokecerebrovasdis.2008.09.007