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Intravenous Delivery of Clot-busting Drug Still Best Intervention for Ischemic Stroke

ew guidelines suggest emergency medical personnel perform a quick stroke assessment, draw blood and alert the hospital that a patient with a suspected stroke is coming. Patients should also be transported to the nearest "appropriate" hospital for emergency stroke care even if that means bypassing the closest facility or calling for air evacuation.

"Appropriate" facilities are those with the expertise and resources to provide modern emergency stroke care. Regional plans for paramedics to bypass institutions that do not have emergency stroke care should be developed, according to the guidelines.

The updated guidelines are an extensive revision of those issued in 2003 and 2005. Among the new or revised recommendations:

Hospitals should develop emergency stroke protocols so patients can be assessed and treated within 60 minutes of arrival in an emergency treatment center.

More medical centers should seek certification as primary or comprehensive stroke centers from the Joint Commission on Accreditation of Healthcare Organizations.

Patients should receive early and carefully chosen treatments for abnormal blood pressure, fever or abnormal blood sugar levels, which can negatively affect stroke outcome.

Although clot-dissolving drugs other than tPA are being tested, none has been established as effective and they should only be given as part of a clinical trial. For the first time, the association has included comments about palliative or comfort care of a patient with a devastating brain injury.

"We included this in the document so that physicians may recognize that they can take measures to not prolong suffering or dying in a patient whose extensive brain injury will result in a fatal outcome," Adams said.

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