NDLI: Adherence to guidelines by emergency medical services during transport of stroke patients receiving intravenous thrombolytic infusion.

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Adherence to guidelines by emergency medical services during transport of stroke patients receiving intravenous thrombolytic infusion.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Asaithambi, Ganesh Chaudhry, Saqib A. Hassan, Ameer E. Rodriguez, Gustavo J. Suri, M. Fareed K. Qureshi, Adnan I.
Description	Author Affiliation: Asaithambi G ( Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, and Hennepin County Medical Center, Minneapolis, Minnesota. Electronic address: ganesh785@gmail.com.)
Abstract	BACKGROUND: The 'drip and ship' paradigm among acute ischemic stroke (AIS) patients has resulted in expansion of thrombolytic treatment in patients eligible for intravenous (IV) recombinant tissue plasminogen activator (rt-PA). It remains controversial whether the settings within the emergency medical services (EMS) transport are adequate for IV rt-PA infusion. We sought to determine EMS adherence to guidelines during the transport of drip and ship AIS patients treated with IV rt-PA while being transferred to comprehensive stroke centers (CSCs) and the effect of nonadherence on outcome upon discharge. METHODS: A retrospective evaluation of patients transferred to our CSC was conducted to determine the rates of adherence to quality parameters during EMS transport with infusion of IV rt-PA. Favorable outcome was defined as modified Rankin Scale (mRS) score ≤ 1 upon discharge. RESULTS: Among the 40 patients studied (55% men; mean age 71.9 ± 13.9 years), 38 patients received vital sign monitoring at 10- to 20-minute intervals. The mean transit time was 37.7 ± 20.2 minutes. Of the 39 patients with blood pressure (BP) monitoring, 7 patients had at least 1 episode of BP elevation above the recommended parameters (>180/105 mm Hg); only 1 of those was treated with an antihypertensive agent. Five of the 40 patients were considered to have worsened between the outside ED and CSC ED evaluations without IV rt-PA discontinuation during transfer. The rate of favorable outcome of patients who had interim neurologic deterioration without discontinuation of IV rt-PA or BP >180/105 mm Hg without antihypertensive treatment was similar to those who experienced neither event (41.7% and 35.7%; P = .736). CONCLUSIONS: Efforts are required to improve EMS adherence to guidelines in patients receiving IV rt-PA during EMS transport in anticipation of broader use of the 'drip and ship' paradigm.
File Format	HTM / HTML
ISSN	10523057
Issue Number	7
Volume Number	22
e-ISSN	15328511
Journal	Journal of Stroke and Cerebrovascular Diseases
Language	English
Publisher	Elsevier
Publisher Date	2013-10-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Brain Ischemia Stroke Humans Middle Aged Drug Therapy Transportation Of Patients Male Administration & Dosage Fibrinolytic Agents Standards Therapeutic Use Journal Article Tissue Plasminogen Activator Guideline Adherence Time Factors Discipline Cardiology Thrombolytic Therapy Practice Guidelines As Topic Female Aged Retrospective Studies Infusions, Intravenous Emergency Medical Services Methods
Content Type	Text
Resource Type	Article
Subject	Rehabilitation Neurology (clinical) Surgery Cardiology and Cardiovascular Medicine

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