Steps to Facilitate Rapid Reperfusion to Improve Poststroke Outcomes

Research advancements in recent years have emphasized an important principle of treating patients with acute ischemic stroke; namely, that faster reperfusion treatment after symptom onset may increase the chances of a better functional outcome. According to an article published in the Annals of Emergency Medicine, minimizing treatment delays after the onset of stroke is imperative for improving global poststroke outcomes, a benefit that can only be achieved by increasing the number of physicians who can assess and rapidly treat stroke at the bedside.

The training of emergency physicians in the absence of neurologic expertise may be an appropriate strategy for reducing poor outcomes frequently reported in patients with stroke, according to the investigators. Emergency physicians may require training on brain computed tomography imaging interpretation to accomplish this goal. In addition, physicians should be made aware of the current literature regarding the benefit of reducing time from stroke onset to reperfusion. Nurses in the emergency department may also require training, and an acute stroke protocol should be implemented in emergency centers.

At this time, standardized education for neurologic training is lacking in global emergency medicine residency programs. Time pressures are increasing for trainees in emergency medicine, further reducing the availability of programs dedicated to stroke training and neurologic emergency. Likewise, the investigators reported that many physicians in the emergency setting are hesitant to make decisions regarding thrombolysis without a formal neurology consultation. In some instances, postresidency training for emergency physicians may be effective.

The researchers also indicated that the assessment and rapid initiation of reperfusion after ischemic stroke may result in time saved, in addition to improved outcomes. “Given the relative paucity of neurologists and the larger number of emergency physicians available for patients with acute ischemic stroke,” the researchers added, “it is incumbent on local stroke systems of care to incorporate their emergency medicine community into the hospital stroke team to the fullest extent possible to maximize the benefits of their involvement and expertise.”

Reference

Jauch EC, Holmstedt CA[KL1] . Fast protocol for treating acute ischemic stroke by emergency physicians: what took so long [published online November 9, 2018]? Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.09.017