22. European Stroke Conference 633 Acute stroke: emergency management, stroke units and complications Thrombolysis at variance with French recommended guidelines: Present fears are less than horrible imaginings (Macbeth). B. Bouamra1, J.F. Bonnet2, L. Vaconnet3, E. MEDEIROS DE BUSTOS4, T. Moulin5 Réseau RUN, CHRU, 25030 Besançon, Besancon, FRANCE1, Faculté de Pharmacie de Besan-con, Besancon, FRANCE2, Réseau RUN, CHRU, 25030 Besançon, Besancon, FRANCE3, Service de Neurologie, CHRU, 25030 Besançon, Besancon, FRANCE4, Service de Neurologie, CHRU, 25030 Besançon, Besancon, FRANCE5 BACKGROUND A study of medical practice based on the stroke registry of the neurological emergencies network in the Franche-Comté region, RUN-FC, in France (2009-2011). Characteristics of the management of stroke patients in the acute phase by intravenous thrombolysis in compliance or at variance with the May 2009 recommendations of the French Health Authority (HAS): “Accident vasculaire cérébral : prise en charge précoce (alerte, phase pré-hospitalière, phase hospitalière initiale, indications de la thrombolyse)”. METHODS All patients who received rt-PA treatment in the initial phase of ischaemic stroke in all hospitals in the region were included (n=247). Presentation of the different characteristics of protocol deviation. Comparison of the two populations in terms of NIH, age, time limit and Rankin score at 3 months. Identification of significant criteria modifying Rankin score at 3 months in the event of protocol de-viation. 682 © 2013 S. Karger AG, Basel Scientific Programme RESULTS During the target period, 63/173 patients received thrombolysis outside of recommendations, mainly in the regional referral stroke unit. Exceeding time limits is the leading cause of protocol deviation. Patients were also significantly older. Rankin at 3 months, as well as mortality, was higher in the group at variance with recommendations. The group at variance with recommendations can be split into two subgroups: one where a considered medical decision was made on the administration of rt- PA, and one where a medical decision was made, but without deliberation. A Rankin score less than or equal to 1 is significantly more frequent in the group where a judgement was made. CONCLUSION Some thrombolyses outside of recommendations seem lawful in terms of benefit for the patient, provided that the decision-making process is clearly defined and argued. The definition of “rescue thrombolysis” is manifestly an occasional but real practice necessitating a clear definition on the one hand and assessment in terms of efficiency on the other. 634 Acute stroke: emergency management, stroke units and complications ER-videomonitoring markedly shorten in-hospital delays for reperfusion in acute stroke E. Sanjuan1, M. Rubiera2, M. Ribo3, M. Muchada4, J. Kallas5, P. Meler6, J. Pagola7, D. Rodri-guez- Luna8, A. Flores9, C.A. Molina10 Vall d’Hebron Hospital, Barcelona, SPAIN1, Vall d’Hebron Hospital, Barcelona, SPAIN2, Vall d’Hebron Hospital, Barcelona, SPAIN3, Vall d’Hebron Hospital, Barcelona, SPAIN4, Vall d’Hebron Hospital, Barcelona, SPAIN5, Vall d’Hebron Hospital, Barcelona, SPAIN6, Vall d’Hebron Hospital, Barcelona, SPAIN7, Vall d’Hebron Hospital, Barcelona, SPAIN8, Vall d’Hebron Hospital, Barcelona, SPAIN9,Vall d’Hebron Hospital, Barcelona, SPAIN10 Background Shortening door-to-needle time is one of the major goals of reperfusion therapy for acute stroke. Re-al- time video-monitoring provides 24/7 expert support and may potentially accelerate actions taken and improve the decision-making in candidates for reperfusion. We aimed to evaluate the impact of real-time videomonitoring on shortening in-hospital time delays for reperfusion therapy. Methods We evaluated consecutive patients admitted on ER who underwent stroke code activation during 1year-period (2012). All were emergently evaluated by a Stroke Neurologist either in a designated stroke box with real-time video recording monitoring (VM) or in a conventional box without VM (NonVM). In all patients, time delays were prospectively collected in specific worksheets. VM was conducted by an experienced stroke researcher who timed and stored images at pre-specified time-points and encouraged speediness of the evaluation process. Results 167 patients were evaluated, 75 in VM box and 92 NonVM. There were no significant differences between groups in baseline characteristics: Age (VM 72 ±14 vs. 72±12 in NonVM patients), gender (58,7% and 51% of men), mean time from symptoms onset to admission (106 vs. 116min) and base-line NIHSS score was 9 in both groups. In the VM group the mean time for blood sampling was 4min±3, and duration of TCD exam 6min±4. Overall mean time in box was 12min±5. VM significantly reduces the time to fist neuro-logical evaluation <5min (VM 95,8% vs. NonVM 67,5%), p=0.001. Door-to-CT time was <25min-utes in VM (59,1%) compared to NonVM (30,1%), p=0.0001. 37% of VM and 34,7% of NonVM patients received reperfusion therapy. The goal of door-to-needle <40min was achieved in 87.5% of VM compared to only 51,7% of NonVM patients (p=0.016). Conclusion Real-time VM markedly reduces in-hospital delays for reperfusion therapy by shortening time to neurological evaluation, time to CT, and door-to-needle times.
Karger_ESC London_2013
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