Research Shows Ways to Speed Stroke Care
Studies looked at improvements in ER, specially equipped ambulance that could deliver clot-busting drug
By Dennis Thompson
WEDNESDAY, April 23, 2014 (HealthDay News) -- Every minute counts for stroke victims who need clot-busting medications quickly to restore blood flow to their brain and prevent further damage.
Now, new efforts to hasten treatment in both ambulances and emergency rooms appear to have significantly improved patients' chances of survival and limited their long-term disability, according to a pair of studies in the April 23/30 issue of the Journal of the American Medical Association.
A quality improvement initiative in hospital emergency departments significantly reduced the time it took for doctors to begin treatment of stroke patients with a clot-busting medication called tissue plasminogen activator (tPA), the first study found.
But a specialized ambulance equipped to start stroke treatment on the way to the hospital cut that time even more, according to another study in the same issue of the journal.
One expert, who wrote an editorial accompanying the findings, said the results were impressive.
"These are completely complementary strategies, and both of them should be implemented," said Dr. James Grotta, director of Stroke Research, Clinical Innovation & Research Institute at Memorial Hermann-Texas Medical Center in Houston. "We should be able with both to increase the number of patients completely recovering from their stroke."
National guidelines recommend that stroke patients eligible for tPA treatment start receiving the drug intravenously within an hour of arriving at the hospital. Unfortunately, fewer than one-third of patients receive it within that timeframe, researchers report in background information.
With that in mind, the American Heart Association launched the Target: Stroke initiative in 2010, arming participating hospitals with a to-do list intended to cut down on "door-to-needle" time for tPA treatment.
The initiative focused on rapid triage, quick turnaround on CT scans and lab tests, and improved ER access to intravenous tPA. Its motto: "Time lost is brain lost."
A study of 71,169 patients treated with tPA at 1,030 participating hospitals found that the Target: Stroke guidelines:
- Reduced the numbers of deaths suffered by stroke patients.
- Improved patients' ability to return home after treatment, with no time spent in a rehabilitation center.
- Increased the number of patients able to get around on their own following a stroke.
- Cut 10 minutes off the average time it took to administer tPA.
- Increased the number of people receiving tPA within an hour to 41 percent from 26 percent.
- Boosted by fourfold the annual rate of improvement in door-to-needle times of an hour or less.
"We saw a very clear impact of the program in the speed at which tPA was delivered," said study author Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the UCLA Preventative Cardiology Program and associate chief of the UCLA Division of Cardiology. "It's rare that you see such a change in results before and after an initiative."