Swiss guidelines for the prehospital phase in suspected acute stroke

Clinical and Translational Neuroscience

Emmanuel Carrera¹  Paul Imboden²  Gian Marco De Marchis³  Stefan Engelter⁴  Andreas Luft⁵  Krassen Nedeltchev⁶  Marcel Arnold⁷  Urs Fischer⁷  Patrik Michel⁸  Georg Kägi⁹  Carlo Cereda^1,10  Christophe Bonvin^1,11  Susanne Renaud^1,12  Olivier Nyenhuis^1,13  David Schurter^1,14  Patrick Arni^1,15  Julien Niederhäuser^1,16 

[1] , Geneva, Switzerland;Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, Kantonsspital St. Gallen, Switzerland;Department of Neurology and Stroke Centre, , Basel, Switzerland;Department of Neurology and Stroke Centre, , Basel, Switzerland;Neurorehabilitation Felix Platter, , Basel, Switzerland;Department of Neurology,and Cereneo, Vitznau, Switzerland;Department of Neurology, , Aarau, Switzerland;Department of Neurology, , Bern, Switzerland;Department of Neurology, , Lausanne, Switzerland;Department of Neurology, , St. Gallen, Switzerland;Department of Neurology, Neurocentro della Svizzera Italiana, Lugano Civic Hospital, Lugano, Switzerland;Division of Neurology and Stroke Unit, , Sion, Switzerland;Division of Neurology, , Neuchâtel, Switzerland;Inter Association of Rescue Services, Bern, Switzerland;Protection & Rescue Zurich, Ambulance, Zurich, Switzerland;Protection and Rescue Bern, Medical Police, Bern, Switzerland;Stroke Unit, Groupement Hospitalier de l’Ouest Lémanique, Nyon, Switzerland;

关键词: Stroke;    prehospital;    guidelines;    Swiss;    large vessel occlusion;   

DOI  :  10.1177/2514183X21999230

来源: Sage Journals

【 摘 要 】

Acute stroke treatment has advanced substantially over the last years. Important milestones constitute intravenous thrombolysis, endovascular therapy (EVT), and treatment of stroke patients in dedicated units (stroke units). At present in Switzerland there are 13 certified stroke units and 10 certified EVT-capable stroke centers. Emerging challenges for the prehospital pathways are that (i) acute stroke treatment remains very time sensitive, (ii) the time window for acute stroke treatment has opened up to 24 h in selected cases, and (iii) EVT is only available in stroke centers. The goal of the current guideline is to standardize the prehospital phase of patients with acute stroke for them to receive the optimal treatment without unnecessary delays. Different prehospital models exist. For patients with large vessel occlusion (LVO), the Drip and Ship model is the most commonly used in Switzerland. This model is challenged by the Mothership model where stroke patients with suspected LVO are directly transferred to the stroke center. This latter model is only effective if there is an accurate triage by paramedics, hence the patient may benefit from the right treatment in the right place, without loss of time. Although the Cincinnati Prehospital Stroke Scale is a well-established scale to detect acute stroke in the prehospital setting, it neglects nonmotor symptoms like visual impairment or severe vertigo. Therefore we suggest “acute occurrence of a focal neurological deficit” as the trigger to enter the acute stroke pathway. For the triage whether a patient has a LVO (yes/no), there are a number of scores published. Accuracy of these scores is borderline. Nevertheless, applying the Rapid Arterial Occlusion Evaluation score or a comparable score to recognize patients with LVO may help to speed up and triage prehospital pathways. Ultimately, the decision of which model to use in which stroke network will depend on local (e.g. geographical) characteristics.

【 授权许可】

CC BY   
© The Author(s) 2021

【 图 表 】

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