AHA, ASA develop algorithm to help EMS personnel ID, treat strokes

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The American Heart Association (AHA) and American Stroke Association have developed an algorithm to help emergency medical services (EMS) personnel better identify strokes, assess patients’ conditions and determine the hospital that best meets patients’ needs.

EMS personnel, hospital-based stroke care teams and other healthcare professionals helped design the Severity-based Stroke Triage Algorithm, according to an AHA news release. The committee also reviewed guidelines and studies to help develop the algorithm.

The AHA said the algorithm balances the benefits of early, rapid access to endovascular thrombectomy for patients with suspected large vessel occlusion with the potential harm of delayed initiation of intravenous alteplase.

The co-chairs of the Mission: Lifeline Stroke program are Peter Panagos, MD, of Washington University in St. Louis, and Lee Schwamm, MD, of Harvard Medical School and Massachusetts General Hospital.

The AHA noted that regions in the U.S. have different resources and personnel to treat strokes, so the algorithm might need to be altered depending on the region.

The committee recommended that it was acceptable for EMS personnel to have a 15-minute delay when considering taking a patient to a comprehensive stroke center. If the delay is more than 15 minutes, they should take them to the nearest hospital, although they mentioned a 20- to 30-minute delay could be reasonable in rural communities or communities where large distances separate stroke centers.

“The new algorithm is needed as new innovations in stroke treatment emerge, such as catheters used to remove large clots in the brain,” Panagos said in a news release. “Although the intravenous use of tissue plasminogen activator, or IV r-tPA (alteplase), is still the most common standard for treating many strokes, these newer endovascular treatments are appropriate in certain cases. However, they require specific equipment and specially-trained personnel that aren’t available at all hospitals, especially those in rural or suburban areas. With these available treatment options, the challenge is identifying severe strokes early, before arrival at the hospital, to get patients to the right facility to get the right therapy in the right amount of time.”