EMS RESOURCES ACUTE ISCHEMIC STROKE THERAPIES

You can make a difference. If you know the symptoms of stroke, and which stroke centers offer the latest treatments for acute ischemic stroke (AIS), you can help patients avoid the debilitating effects of stroke. This page will help you understand AIS, the current and the latest treatment options, and the impact of the decisions you make when treating patients actively having a stroke.


WHAT IS A STROKE?

STROKE IS AN EMERGENCY

Fast response, achieved by proper stroke assessment and effective routing to the most comprehensive stroke center can minimize the loss of brain function and reduce long-term disability.1-2

WHAT IS ACUTE ISCHEMIC STROKE?

In a healthy person, blood carries oxygen and nutrients to the brain, and takes away carbon dioxide and cellular waste. If an artery feeding the brain tissue is blocked, the neurons are starved of oxygen and nutrients and will eventually stop functioning. If the artery remains blocked for more than a few minutes, the brain cells may die, resulting in severe neurological damage. If neurons die in an area of the brain that controls a particular part of the body, that part of the body may lose function. The effects of a stroke depend primarily on the extent to which brain region is affected. Restoring blood flow to the brain (revascularization) is the only way to prevent this kind of damage.3

This is why immediate medical treatment is critical. And ensuring that you have the latest and most accurate information about stroke treatment enables you to provide optimal treatment for the stroke patients you encounter.


Every minute a stroke goes untreated;
1.9 million brain cells are lost.4


HOW IS STROKE TREATED?

IvTPA Icon

MEDICAL MANAGEMENT WITH IV t-PA

This method uses a medication called t-PA (Recombinant Tissue Plasminogen Activator) to dissolve the clot and improve blood flow to the brain. It can be administered intravenously (IV). Some patients cannot receive this drug because of other medical conditions or medications they are taking and other patients may not arrive in time from their first primary symptom.5

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MECHANICAL THROMBECTOMY WITH A STENT RETRIEVER

This method involves a minimally invasive surgical procedure that uses a tiny device called a stent retriever to remove blood clots in the brain, restoring blood flow. Since 2013, pivotal new evidence reported from eight randomized clinical trials⁶ justified changes in the American Heart Association/ American Stroke Association (AHA/ASA) guidelines supporting this treatment for AIS patients meeting specific criteria. The 2015 AHA/ASA guidelines now recommend the use of endovascular treatment with stent retrievers, in addition to IV t-PA, for eligible patients experiencing acute ischemic stroke.5 Learn more about stent retriever thrombectomy.

HOW SHOULD EMS RESPOND?

1. IDENTIFY

Recognize Stroke Symptoms Fast.

Speed to diagnosis is critical to minimize brain injury and maximize the patient’s recovery from stroke. That’s why, as an EMS team member, you must be able to quickly identify the presence of a stroke and decide the best way to get the patient to proper care.2

2. EVALUATE

Use Assessment Tools Properly.

Several tools can be used in the field to help identify the symptoms of stroke. Some of the most popular are:

3. NOTIFY

Transportation Protocols and Communication with Hospital.

Hospital pre-notification by EMS of incoming patients with potential stroke may reduce the time needed to evaluate and treat - which may improve treatment rates.10 This may not only save time but also save brain cells lost with the passing of time.2

4. ROUTE

Transfer to Comprehensive Stroke Centers When Available.

Transportation to the most comprehensive stroke center is highly recommended. Comprehensive Stroke Centers (CSC) have the capability to support all needed levels of care to stroke patients, including special interventions and highly technical procedures. A recent publication demonstrated high volume stroke centers with endovascular capabilities have lower procedural times, higher reperfusion rates and better clinical outcomes.11Transportation to the right hospital may be the key in saving a patient from long-term disability and death.10

CONTINUING EDUCATION

Art Icon Training

EMS Practitioners

Medtronic offers free continuing education on acute ischemic stroke treatment for paramedics at www.americancme.com


1

Khatri P, Abruzzo T, Yeatts SD, et al. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology. September 29, 2009 2009;73(13):1066-1072.

2

Maggiore, W. A. (2012). ‘Time is Brain’ in Prehospital Stroke Treatment. Journal of Emergency Medical Services, 1-9.

3

Broyles R. Pathophysiology of Cerebrovascular Accident. 2009. 

4

Saver JL. Time Is Brain—Quantified. Stroke. January 1, 2006;37(1):263-266.

5

Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. Oct 2015;46(10):3020-3035.

6

SYNTHESIS Expansion, IMS III, MR RESCUE, MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA, and REVASCAT.

7

Adapted from: Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. “Cincinnati Prehospital Stroke Scale: reproducibility and validity.” Ann Emerg Med 1999 Apr;33(4):373-8, permission for use.

8

Adapted from: Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. “Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS).” Stroke 2000 Jan;31(1):71-6.

9

Adapted from: Perez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke; a journal of cerebral circulation. Jan 2014;45(1):87-91.

10

Lin CB, Peterson ED, Smith EE, et al. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circulation. Cardiovascular quality and outcomes. Jul 1 2012;5(4):514-522.

11

Gupta R, Horev A, Nguyen T, et al. Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes. J. Neurointerv. Surg. Jul 2013;5(4):294-297.