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Prehospital Thrombolysis: A Manual from Berlin

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Published on: November 26, 2013

Rapid Thrombolysis Protocol: Results from a Before-and-after Study.

Ankur Verma¹, Shivani Sarda¹, Sanjay Jaiswal¹

¹Department of Emergency Medicine, Max Super Speciality Hospital, New Delhi, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine

|June 20, 2022

Summary

A new rapid thrombolysis protocol (RTPr) significantly reduced door-to-needle (DTN) times for stroke patients, improving outcomes. This protocol can be adopted to enhance emergency stroke care.

Keywords:

Ischemia Rapid thrombolysis protocol Stroke Thrombolysis Tissue plasminogen activator

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Area of Science:

Emergency Medicine
Neurology
Clinical Protocols

Background:

Intravenous thrombolysis is a critical treatment for acute ischemic stroke, with established benefits within 4.5 hours of onset.
The standard goal for door-to-needle (DTN) time in emergency departments is within 60 minutes of patient arrival.
Current processes may delay thrombolysis, impacting patient outcomes.

Purpose of the Study:

To evaluate the effectiveness of a novel rapid thrombolysis protocol (RTPr) in reducing DTN times.
To assess the impact of the RTPr on patient recovery and functional outcomes after stroke.
To determine if the RTPr can be implemented to improve stroke care efficiency.

Main Methods:

A before-and-after study design was employed at a single center.
Patients receiving intravenous thrombolysis were divided into pre-intervention (standard care) and post-intervention (RTPr) groups.
Primary outcomes included DTN time, time to recovery, and modified Rankin Scale (mRS) score at discharge; secondary outcomes included mortality and complications.

Main Results:

The mean DTN time was significantly reduced from 56.15 minutes in the pre-intervention group to 34.91 minutes in the post-intervention group (p < 0.001).
Neurological recovery within 24 hours was observed in 43.24% of the pre-intervention group and 41.89% of the post-intervention group.
A favorable discharge mRS score (0-2) was achieved by 36.49% of patients in the pre-intervention group and 54.05% in the post-intervention group.

Conclusions:

The rapid thrombolysis protocol (RTPr) effectively decreases door-to-needle times in stroke patients.
Implementation of the RTPr is associated with improved functional outcomes at discharge.
Clinicians and hospitals can adapt this protocol to optimize emergency stroke treatment and patient care.