Time Goals for Assessment & Treatment of Stroke

When treating patients having an MI or stroke, remember that more minutes equals more dead cells. Rapid identification, calling for help, and providing appropriate timely care has been shown to improve stroke outcomes. Similar to our timed goals for treating STEMI patients, there are time-specific clinical requirements and benchmark goals for stroke. Reviewing the time-based goals for the assessment & treatment of stroke patients is today’s Pass ACLS tip topic.

Chain of Survival

Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI; to open the blocked vessel & reestablish perfusion to the ischemic tissues.  In an MI that would be the heart and in a stroke the brain.
The chain of survival for a stroke is similar to heart attack:

1. Recognize the symptoms of a stroke;
2. call 9-1-1;
3. EMS transport to the most appropriate facility;
4. followed by rapid confirmation and definitive treatment.

Timed Clinical Treatment & QA/PI Benchmark Goals

Fibrinolytic therapy by administration of tPA (or a similar medication) is most effective if given within three (3) hours of the onset of symptoms.  For patients that awaken with stroke symptoms, our goal for administration of thrombolytics is within four and a half (4.5) hours of when the patient was last seen well.

Patients that arrive at the hospital with stroke symptoms should have the following actions completed within these established times:

• A general assessment completed within 10 minutes of arrival;
• A non-contrast CT of the head to differentiate between an ischemic and hemorrhagic stroke should be completed within 20 minutes and read within 45; and
• Administration of tPA (or similar) within 60 minutes of arrival.  (door-to-needle time)

Stroke centers have specialized teams that improve stroke patient’s outcomes by rapidly recognizing a stroke and providing the most appropriate & timely evidence-based care.  Depending on the area, EMS may bypass a closer (non-stroke certified) hospital if a certified stroke center is within 30 minutes. Patients with suspected large vessel occlusion (LVO) should be transported to a facility with EVT services so that thrombectomy can be performed within 24 hours of onset of symptoms.  Patients with LVO at a facility without EVT services should be assessed and transferred within 60 minutes of their arrival.

To clarify a point that is often confusing regarding our timed goals:

• The time for treatment of Cardiac patients starts at the point of first medical contact.  For out of hospital patients, this would be contact with EMS.
• For stroke patients, our goals for assessment, imaging, and administration of tPA starts at arrival to the hospital.