Manage episode 220402245 series 1549874
Deciphering signal from noise as it relates to modern stroke care can be challenging and conflicting, especially as it pertains to the out of hospital environment. In this podcast, we brought the knowledge and experience of Dr. Ben Newman: a neurosurgeon and endovascular therapy expert to discuss advances, challenges, and strategies in caring for our stroke patients.
When to Bypass
Perhaps the most challenging decision to make when presented with a patient experiencing an acute stroke is the transport decision. Should we transport them to a Comprehensive Stroke Center (CSC), or to a "thrombolytic capable center"?
The 2018 AHA/ASA Stroke Guidelines state that:
When several IV alteplase–capable hospital options exist within a defined geographic region, the benefit of bypassing the closest to bring the patient to one that offers a higher level of stroke care, including mechanical thrombectomy, is uncertain. Further research is needed.
They also state that the Mission: Lifeline Severity–based Stroke Triage Algorithm for EMS may be reasonable in some circumstances. This algorithm recommends, in some circumstances, transporting the patient to a comprehensive center only if the transport time is "