Guidelines for Management of Ischaemic Stroke 2008 - ESO

ESO-Guidelines for Management of Ischaemic Stroke 2008
for a larger proportion of patients. Most such studies have used a before-and-after
intervention design, were neither randomized nor masked with respect to intervention
or evaluation of outcome, and lacked concurrent controls [23, 53]. The types of
interventions included education and training programmes, helicopter transfer,
telemedicine and reorganization of pre-hospital and in-hospital protocols for acute
stroke patients.
Direct presentation to the ED via ambulance or EMS transportation is the fastest way
of referral [28, 53, 63-65]. Helicopter transport can reduce the time between referral
and hospital arrival [66, 67], and also promotes access to thrombolytic therapy in
remote and rural areas [68]. In mixed rural and urban areas, air and ground distances
can be compared using simple rules [69]. No studies have compared air and ground
transport specifically in stroke patients. In one study, predominantly in trauma
patients, ground ambulances provided shorter arrival times at distances less than 10
miles (≅16 km) from the hospital; even with only short delays in despatching air
transport, air was faster only for distances longer than 45 miles (≅72km) [70]. One
economic study showed that helicopter transfer of patients with suspected acute
ischaemic stroke for potential thrombolysis is cost-effective [71].
Telemedicine using a bidirectional video-conferencing equipment to provide health
services or assist health care personnel at distant sites is a feasible, valid and
reliable means of facilitating thrombolysis delivery to patients in distant or rural
hospitals, where timely air or ground transportation is not feasible. The quality of
treatment, complication rates, and short and long term outcomes are similar for acute
stroke patients treated with rtPA via a telemedicine consultation at local hospitals and
those treated in academic centres [72-81].
Activation of the stroke code as a special infrastructure with immediate calling of a
stroke neurologist at a stroke unit and priority transfer of the patients to this centre is
effective in increasing the percentage of patients treated with thrombolysis, and also
in shortening pre-hospital delays [82, 83].
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