Telemedicine speeds treatment of stroke and reduces the risk of sequelae
Published the 16.12.2017 at 12: 00
“When a stroke occurs, minutes count,” says the lead author of the study, Mai Nguyen-Huynh. A more rapid treatment with a treatment of r-tPA intravenously, dissolves the clot causing the ischemic stroke and restore blood flow in the brain, is strongly associated with better functional outcomes for patients “. A simple treatment but that should only be administered in the form of ischemic and guidance very strict, hence the need for an expert opinion.
Telemedicine speeds up the support
Published in the journal Stroke, this is one of the first studies demonstrating how the successful implementation of protocols for standardised treatment via telemedicine can dramatically reduce the time required to start a treatment that is essential for a STROKE before the maximum period of intervention. The delivery time has been reduced to 34 minutes compared to 53 minutes on average, and the time of administration less than 60 minutes was achieved in 87% of cases compared to 61% in normal procedure.
The guidelines of the American Heart Association and American Stroke Association recommend durations of 60 minutes, maximum, for r-tPA intravenously.
Every second, the patient loses nerve cells
In the case of ischemic stroke, emergency treatment, in a neurovascular unit or in coordination with it, is to dissolve the clot that is clogging the middle cerebral artery in perfusant a drug : we call this treatment the “thrombolysis” by the rt-PA (recombinant tissue-Plasminogen Activator) and it is administered by intra-venous.
This treatment should be done as soon as possible, but in any case within the first 4 hours following the installation of the signs onerous when one is sure of having eliminated a hemorrhage. It will help to restore the flow of blood and oxygen to the brain, and thus limit the extent of brain injury and its sequelae.
Thrombolysis carries a high risk of haemorrhage at the level of the brain and the digestive tract. The decision for thrombolysis should therefore be taken by a doctor specialized in pathology neurovascular after an assessment of contraindications to major (severity of STROKE, cerebral infarct size by imaging, history, blood pressure check, etc.).
A mode of operation accelerated
Telemedicine has been integrated in a complete reorganization of the care of acute STROKE in Northern California. “The process that occur sequentially during a suspected STROKE, one after the other, now occur at the same time, details of the author. This allows us to assess and treat quickly, safely, and with confidence the r-tPA intravenously “.
Each team member is responsible for the execution of the tasks in tandem. Paramedics will alert the emergency department that a patient with a suspected STROKE is coming. A “warning STROKE,” warns a neurologist, who meets the patient at his arrival, in person or by video, to co-ordinate the warning STROKE. The pharmacists quickly prepare medicines anti-clots so that they are ready to be administered as soon as a radiologist read the brain imaging (ct or MRI), and confirmed that the patient did not have a haemorrhagic form of STROKE.
Once it is diagnosed “good candidate” for the r-tPA intravenously, the injection is carried out, which allows the administer 2 times faster than anywhere else in the USA, and therefore limit the extent of STROKE and its sequelae. The percentage of intracranial haemorrhage was not significantly greater with the accelerated procedure through telemedicine (3.8 per cent vs. 2.2 per cent ; NS).
With a very great rapidity of intervention, it is even possible to have no ill effects.