PracticeUpdate Conference Series - ANZAN 2018

Results of Three Studies on Timely Thrombolysis Point to Improved Stroke Care Studies on the Helsinki protocol, the ACT-FAST protocol, and plasmin assay indicated improvement in patients with ischemic stroke.

An evaluation of the implementation of the Helsinki protocol M atthewSilsby, MD, of theConcordRepatriation General Hospital in Concord, NSW, explained that intravenous thrombolysis for acute ischemic stroke is a time-critical intervention. Time to treatment may be reduced by implementingmeas- ures known as the Helsinki protocol. Dr. Silsby and colleagues set out to evaluate imple- mentation of the Helsinki protocol at a large tertiary teaching hospital. The protocol for treatment of acute stroke at Dr. Silsby’s center was modified to mirror the Helsinki protocol. Focus was placed on reducing the time after patient arrival at the hospital, without changing the existing infrastructure. This infrastructure included education of triage staff to improve stroke recognition, patient transfer patients directly from the ambulance to CT scanning, intravenous contrast administration as standard CT imaging, and tissue plasminogen activator prepa- ration during CT scanning. The primary endpoints were door-to-CT and door-to-needle times. Data from stroke calls made were compared from 2016 to 2017. In the 12 months prior to implemen- tation, 156 stroke calls occurred and 26 patients underwent thrombolysis. In the initial 10-week study, 49 stroke calls occurred and seven patients received thrombolysis. Median door-to-needle was reduced significantly (77.5 vs 28 minutes, P = .0477).

In the following 6 months, 93 stroke calls occurred and eight patients underwent thrombolysis. Median door-to-needle time remained significantly reduced (77.5 vs 39 minutes, P = .012). Door-to-CT time was unchanged across the 8-month period (26 vs 23 minutes). Post imple- mentation, fewer patients underwent thrombolysis (17% vs 11%), but the number of calls rose from 13 to 18 per month. Dr. Silsby concluded that introduction of the Helsinki protocol for acute stroke calls resulted in a signif- icant reduction in door-to-needle times. Changes persisted notwithstanding routine changes in jun- ior staff. Fewer patients underwent thrombolysis, despite the focus on minimizing delays. This reduction may have occurred because more calls reflected a preference for sensitivity over specificity. Reduction in door-to-needle times car- ries significant implications for patient recovery. Effects of simple process changes persist beyond the dedicated study period. Ambulance clinical triage-for acute stroke treatment (ACT-FAST) algorithmic pre-hospital triage tool for endovascular thrombectomy Bruce C.V. Campbell, MBBS, BMedSc, PhD, of the Royal Melbourne Hospital in Melbourne, Victoria, explained that the ACT-FAST algorithm is a sever- ity-based, three-step paramedic triage tool for prehospital recognition of large vessel occlusion.

Dr. Bruce C.V. Campbell

Dr. Henry Zhao

PRACTICEUPDATE CONFERENCE SERIES • ANZAN 2018 20