A team of researchers have reduced the median time from hospital arrival to thrombolysis to 20 minutes for patients with ischemic stroke, according to a study published in the July 24 Neurology.
Atte Meretoja, MD, a neurologist at Helsinki University Central Hospital, and colleagues found that 31% of patients with ischemic stroke admitted to the hospital in 2011 received rt-PA, and 94% of these patients were treated within 60 minutes of arrival. Patients who had stroke while in the hospital and those who arrived soon after symptom onset had longer delays to treatment because hospital staff had less time to prepare.
Dr. Meretoja’s group studied 1,860 patients with ischemic stroke who were treated with IV alteplase at the hospital between June 1995 and June 2011. From 1998 to 2011, the investigators conducted various interventions to reduce treatment delays. These measures included obtaining patients’ history and provisional consent for rt-PA treatment by telephone, and taking patients directly from emergency medical transport to the CT scanner.
Median door-to-needle time in 1998 was 105 minutes, and the researchers reduced that time to 60 minutes by 2003 and to 20 minutes by 2011. “The key is to do as little as possible after the patient has arrived at the emergency room and as much as possible before that,” said Dr. Meretoja.
Given the researchers’ success, “it is an ethical imperative for us to work toward similar results in our own hospitals,” said Eric E. Smith, MD, Assistant Professor of Neurology at the University of Calgary in Canada, and Rudiger von Kummer, MD, Director of the Dresden University Stroke Center in Germany, in an accompanying editorial. However, “it is important that enough time be reserved for accurate clinical evaluation, including identification of contraindications to rt-PA,” and an emphasis on prehospital care is warranted, they added.
Meretoja A, Strbian D, Mustanoja S, et al. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79(4):306-313.
Smith EE, von Kummer R. Door-to-needle times in acute ischemic stroke: how low can we go? Neurology. 2012;79(4):296-297.