Importance of Pre- and In–Hospital Cooperation for Accelerating the Initiation of Mechanical Thrombectomy

Abstract

  In the treatment of acute ischemic stroke, it is important to start the administration of tissue plasminogen activator (tPA) and mechanical thrombectomy as soon as possible. We created an acute stroke medical treatment algorithm that we named ‘stroke scramble’ which accelerated the pre- and in-hospital cooperation and began using it in February 2015. After the introduction of this algorithm, an ambulance staff, an emergency outpatient nurse, a radiologist, and a nurse in charge of the angiography room each devised a way to further shorten the length of time before the administration of tPA and the start of mechanical thrombectomy. We also began using the GAI₂AA scale in March 2017, and in cases in which the GAI₂AA score was ≥ 3 points, we confirmed that there was no bleeding by CT and then skipped the MRI and took the patient to the angiography room. As a result, it was 27 min before the administration of tPA and 56 min before the start of mechanical thrombectomy. In conclusion, tPA treatment and mechanical thrombectomy can be started sooner by evaluating the patient’s status based on the pre-hospital information obtained from the ambulance team, scoring the GAI₂AA, and preparing the in-hospital cooperation system before patient’s arrival.