Skip to main content
SpringerLink
Log in

How to Run an Effective Code Stroke

  • Chapter
  • First Online:
Thrombolytic Therapy for Acute Stroke

  • 1588 Accesses

Abstract

The urgency of Code Stroke is founded on the rapidly evolving brain injury during acute cerebral infarction, and the time-sensitive effectiveness of thrombolytic therapy. Lay public and Emergency Medical Services awareness can lead to earlier arrival of acute stroke victims in Emergency Departments, increasing the chance of effective thrombolytic therapy. Specially established Stroke Teams at certified Stroke Centers are ideal for raising stroke awareness and optimizing acute therapy to improve outcomes. Stroke Teams ideally should include a diverse group of health care providers, supported by hospital administration, working in concert. Efficient evaluation of acute stroke victims includes urgent assessment with concomitant acquisition of a focused history, a focused physical examination, rapid neuroimaging, and pertinent blood tests. Based on these evaluations a decision can be made whether to recommend thrombolytic therapy. Additional acute therapies are aimed at preventing complications. Code stroke should swiftly transition from the Emergency Department to a specialized Stroke Unit for continued specialized care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.

    Google Scholar 

  2. Alberts MJ, Hademenos G, Latchaw RE, et al. Recommendations for the establishment of primary stroke centers. Brain attack coalition. JAMA. 2000;283:3102–9.

    Article  CAS  PubMed  Google Scholar 

  3. Alberts MJ, Latchaw RE, Selman WR, et al. Recommendations for comprehensive stroke centers. Stroke. 2005;36:1597–616.

    Article  PubMed  Google Scholar 

  4. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.[see comment]. N Engl J Med. 2008;359:1317–29.

    Article  CAS  PubMed  Google Scholar 

  5. group ISTc, Sandercock P, Wardlaw JM, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379:2352–63.

    Article  PubMed  Google Scholar 

  6. Fonarow GC, Smith EE, Saver JL, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: stroke initiative. Stroke. 2011;42:2983–9.

    Article  PubMed  Google Scholar 

  7. Schwamm LH, Pancioli A, Acker 3rd JE, et al. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association’s Task Force on the Development of Stroke Systems. Stroke. 2005;36:690–703.

    Article  PubMed  Google Scholar 

  8. Schwamm LH, Audebert HJ, Amarenco P, et al. Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke. 2009;40:2635–60.

    Article  PubMed  Google Scholar 

  9. Saver JL. Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke. Arch Neurol. 2004;61:1066–70.

    Article  PubMed  Google Scholar 

  10. Lyden P, Lu M, Jackson C, et al. Underlying structure of the National Institutes of Health Stroke Scale: results of a factor analysis. NINDS tPA stroke trial investigators. Stroke. 1999;30:2347–54.

    Article  CAS  PubMed  Google Scholar 

  11. Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke. 2000;31:71–6.

    Article  CAS  PubMed  Google Scholar 

  12. Llanes JN, Kidwell CS, Starkman S, Leary MC, Eckstein M, Saver JL. The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field. Prehosp Emerg Care. 2004;8:46–50.

    Article  PubMed  Google Scholar 

  13. Nazliel B, Starkman S, Liebeskind DS, et al. A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions. Stroke. 2008;39:2264–7.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375:1695–703.

    Article  CAS  PubMed  Google Scholar 

  15. Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. The NINDS t-PA Stroke Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group. Stroke. 1997;28:2109–18.

    Article  Google Scholar 

  17. Jauch EC, Saver JL, Adams Jr HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.

    Article  PubMed  Google Scholar 

  18. Levy DE. How transient are transient ischemic attacks? Neurology. 1988;38:674–7.

    Article  CAS  PubMed  Google Scholar 

  19. The Re-examining Acute Eligibility for Thrombolysis Task Force, Levine SR, Khatri P, et al. Review, historical context, and clarifications of the NINDS rt-PA stroke trials exclusion criteria: part 1: rapidly improving stroke symptoms. Stroke. 2013;44:2500–5.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Chernyshev OY, Martin-Schild S, Albright KC, et al. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010;74:1340–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79:306–13.

    Article  PubMed  Google Scholar 

  22. Ahmed N, Nasman P, Wahlgren NG. Effect of intravenous nimodipine on blood pressure and outcome after acute stroke. Stroke. 2000;31:1250–5.

    Article  CAS  PubMed  Google Scholar 

  23. Bruno A, Biller J, Adams Jr HP, et al. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999;52:280–4.

    Article  CAS  PubMed  Google Scholar 

  24. Bruno A, Levine SR, Frankel MR, et al. Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial. Neurology. 2002;59:669–74.

    Article  CAS  PubMed  Google Scholar 

  25. Bruno A, Durkalski VL, Hall CE, et al. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke. Int J Stroke. 2013;9:246–51.

    Article  PubMed  Google Scholar 

  26. Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG. Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet. 2000;356:894–9.

    Article  CAS  PubMed  Google Scholar 

  27. Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim LL, Holme I. Benefit of a stroke unit: a randomized controlled trial. Stroke. 1991;22:1026–31.

    Article  CAS  PubMed  Google Scholar 

  28. Indredavik B, Slordahl SA, Bakke F, Rokseth R, Haheim LL. Stroke unit treatment. Long-term effects. Stroke. 1997;28:1861–6.

    Article  CAS  PubMed  Google Scholar 

  29. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke. 1998;29:895–9.

    Article  CAS  PubMed  Google Scholar 

  30. Langhorne P, Williams BO, Gilchrist W, Howie K. Do stroke units save lives? Lancet. 1993;342:395–8.

    Article  CAS  PubMed  Google Scholar 

  31. Levine SR, Gorman M. “Telestroke”: the application of telemedicine for stroke. Stroke. 1999;30:464–9.

    Article  CAS  PubMed  Google Scholar 

  32. Wang S, Lee SB, Pardue C, et al. Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke. 2003;34:e188–91.

    Article  PubMed  Google Scholar 

  33. Shafqat S, Kvedar JC, Guanci MM, Chang Y, Schwamm LH. Role for telemedicine in acute stroke. Feasibility and reliability of remote administration of the NIH stroke scale. Stroke. 1999;30:2141–5.

    Article  CAS  PubMed  Google Scholar 

  34. Puetz V, Bodechtel U, Gerber JC, et al. Reliability of brain CT evaluation by stroke neurologists in telemedicine. Neurology. 2013;80:332–8.

    Article  PubMed  Google Scholar 

  35. Hess DC, Wang S, Hamilton W, et al. REACH: clinical feasibility of a rural telestroke network. Stroke. 2005;36:2018–20.

    Article  PubMed  Google Scholar 

  36. Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL. Effects of the implementation of a telemedical stroke network: the telemedic pilot project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol. 2006;5:742–8.

    Article  PubMed  Google Scholar 

  37. Nelson RE, Saltzman GM, Skalabrin EJ, Demaerschalk BM, Majersik JJ. The cost-effectiveness of telestroke in the treatment of acute ischemic stroke. Neurology. 2011;77:1590–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ. Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Qual Outcomes. 2013;6:18–26.

    Article  PubMed  Google Scholar 

  39. Silva GS, Farrell S, Shandra E, Viswanathan A, Schwamm LH. The status of telestroke in the United States: a survey of currently active stroke telemedicine programs. Stroke. 2012;43:2078–85.

    Article  PubMed  Google Scholar 

  40. Schwamm LH, Holloway RG, Amarenco P, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40:2616–34.

    Article  PubMed  Google Scholar 

  41. Adams RJ, Debenham E, Chalela J, et al. REACH MUSC: a telemedicine facilitated network for stroke: initial operational experience. Front Neurol. 2012;3:33.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Bruno A, Lanning KM, Gross H, Hess DC, Nichols FT, Switzer JA. Timeliness of intravenous thrombolysis via telestroke in Georgia. Stroke. 2013;44:2620–2.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, BI 3076, Augusta, GA, 30912, USA

    Jeffrey A. Switzer D.O., M.C.T.S. & Askiel Bruno M.D., M.S.

Authors
  1. Jeffrey A. Switzer D.O., M.C.T.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Askiel Bruno M.D., M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Askiel Bruno M.D., M.S. .

Editor information

Editors and Affiliations

  1. Stroke Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Patrick D Lyden

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Switzer, J.A., Bruno, A. (2015). How to Run an Effective Code Stroke. In: Lyden, P. (eds) Thrombolytic Therapy for Acute Stroke. Springer, Cham. https://doi.org/10.1007/978-3-319-07575-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07575-4_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07574-7

  • Online ISBN: 978-3-319-07575-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation