<p>Acute Ischemic Stroke Management: A Clinical Audit in Accordance with the 2019 AHA Guidelines</p>

Background and ObjectivesMultidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees’ education which in turn may contribute to poorer outcomes in community hospitals upon graduation. Our goal was to assess graduate neurology trainee performance independent of a multi-disciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)-related hemorrhage, and cerebral herniation syndrome.MethodsIn this prospective, observational, single-center simulation-based study, participants (sub-interns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was graduate neurology trainees’ critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training.ResultsFifty-three trainees (including 31 graduate neurology trainees) and five attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15/22 (68%). Ninety percent of graduate neurology trainees properly administered tPA, 84% immediately stopped tPA infusion following patient deterioration, but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean score [standard deviation (SD)] = 7.2 (2.8) vs. level 2 mean score (SD) = 12.3 (2.6) vs. level 3 mean score (SD) = 13.3 (2.2) vs. level 4 mean score (SD) = 16.3 (2.4), p < .001, R2 = 0.54).DiscussionGraduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke, but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

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Diagnostic imaging for acute ischemic stroke management

Expert Review of Medical Devices ◽

10.1586/17434440.3.1.113 ◽

2006 ◽

Vol 3 (1) ◽

pp. 113-126 ◽

Cited By ~ 4

Author(s):

Eric Jüttler ◽

Jochen B Fiebach ◽

Peter D Schellinger

Keyword(s):

Ischemic Stroke ◽

Diagnostic Imaging ◽

Acute Ischemic Stroke ◽

Stroke Management

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Stroke Management: Nursing Roles

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.ca1.49 ◽

2017 ◽

pp. 49

Author(s):

Maryam Esmaeili

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Key Management ◽

Initial Phase ◽

Fluid Management ◽

Pressure Control ◽

Stroke Management ◽

Neurologic Symptoms

Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms.Methods: This is a review paper that report up to date finding with review some research papers and databases.Results: Sudden loss of focal brain function is the core feature of the onset of ischemic stroke. However, patients with conditions other than brain ischemia may present in a similar fashion. The goals in the initial phase include: ensuring medical stability, with particular attention to airway, breathing, and circulation, quickly reversing any conditions that are contributing to the patient's problem, determining if patients with acute ischemic stroke are candidates for thrombolytic therapy, moving toward uncovering the pathophysiologic basis of the patient's neurologic symptoms. Time is of the essence in the hyperacute evaluation of stroke patients. In addition to stabilization of airway, breathing, and circulation, and rapid neurologic evaluation, early key management issues that often arise in acute stroke include blood pressure control, fluid management, treatment of abnormal blood glucose levels, swallowing assessment and treatment of fever and infection. Care in a dedicated stroke unit is associated with better outcomes.Conclusion: The main goals in the initial phase of acute stroke management are to ensure medical stability, to quickly reverse conditions that are contributing to the patient's problem, to determine if patients with acute ischemic stroke are candidates for thrombolytic therapy, and to begin to uncover the pathophysiologic basis of the neurologic symptoms.

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Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion

Cureus ◽

10.7759/cureus.3842 ◽

2019 ◽

Author(s):

Taylor S Harmon ◽

Paul C Hulsberg ◽

Joseph R McFarland ◽

Victoria V Villescas ◽

Jerry Matteo

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Management ◽

The Future

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Acute ischemic stroke management: concepts and controversies.A narrative review

Expert Review of Neurotherapeutics ◽

10.1080/14737175.2021.1836963 ◽

2020 ◽

Vol 21 (1) ◽

pp. 65-79

Author(s):

Ka Hou Christien Li ◽

Aaron Jesuthasan ◽

Christopher Kui ◽

Ruth Davies ◽

Gary Tse ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Narrative Review ◽

Stroke Management ◽

Management Concepts

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Cutting Edge Acute Ischemic Stroke Management

Emergency Medicine Clinics of North America ◽

10.1016/j.emc.2019.03.001 ◽

2019 ◽

Vol 37 (3) ◽

pp. 365-379 ◽

Cited By ~ 1

Author(s):

Alfredo E. Urdaneta ◽

Paulomi Bhalla

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cutting Edge ◽

Stroke Management

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Use of Intravenous Thrombolysis in Acute Ischemic Stroke Management in Patients with Active Malignancies: A Topical Review

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.105728 ◽

2021 ◽

Vol 30 (6) ◽

pp. 105728

Author(s):

Asma Akbar Ladak ◽

Sonia Sandhu ◽

Ahmed Itrat

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Stroke Management ◽

Topical Review

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Acute Stroke Management During the COVID-19 Pandemic

Stroke ◽

10.1161/strokeaha.120.030794 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2593-2596 ◽

Cited By ~ 8

Author(s):

Steven D. Hajdu ◽

Valerie Pittet ◽

Francesco Puccinelli ◽

Wagih Ben Hassen ◽

Malek Ben Maacha ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Study Data ◽

Stroke Onset ◽

World Health ◽

Stroke Management ◽

Vessel Occlusion ◽

Wilcoxon Rank Sum Test ◽

Health Organization

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8–10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5–7.7]), ( P <0.001). In addition, there is a significant increase in mean stroke onset-to-groin puncture time ( P <0.001), between before COVID-19 confinement (300.3 minutes [95% CI, 285.3–315.4]) and after COVID-19 confinement (354.5 minutes [95% CI, 316.2–392.7]). Our preliminary analysis indicates a 32% reduction in EVT procedures and an estimated 54-minute increase in symptom onset-to-groin puncture time after confinement measures for COVID-19 pandemic were put into place.

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