Poor Hypertension Control and Longer Transport Times Are Associated with Worse Outcome in Drip-and-Ship Stroke Patients

Kodankandath, Thomas V.; Shaji, Jane; Kohn, Nina; Arora, Rohan; Salamon, Elliott; Libman, Richard B.; Katz, Jeffrey M.

doi:10.1016/j.jstrokecerebrovasdis.2016.04.013

Cited by 13 publications

(2 citation statements)

References 18 publications

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“…Similar recommendations were also made by the ESO 49. This blood pressure target was derived from the exclusion criteria in RCTs that examined the effects of thrombolytics in AIS patients, and, while several observational studies have similarly demonstrated an association between elevated systemic blood pressure and hemorrhagic conversion and/or worsened neurological outcomes following tPA, the exact upper-limit blood pressure target remains unclear 90,108–112…”

Section: Aismentioning

confidence: 99%

“…49 This blood pressure target was derived from the exclusion criteria in RCTs that examined the effects of thrombolytics in AIS patients, and, while several observational studies have similarly demonstrated an association between elevated systemic blood pressure and hemorrhagic conversion and/or worsened neurological outcomes following tPA, the exact upper-limit blood pressure target remains unclear. 90,[108][109][110][111][112] Anderson et al 113 attempted to address this question in the Enhanced Control of Hypertension and Thrombolysis Stroke (ENCHANTED) study. The ENCHANTED trial was an international, multicenter, prospective RCT in which 2196 alteplase-eligible AIS patients within 6 hours of stroke onset were randomized to either an intensive blood pressure-lowering group (SBP 130 to 140 mm Hg within 1 h) or a guideline treatment group (SBP <180 mm Hg) for 72 hours following tPA administration.…”

Section: Aismentioning

confidence: 99%

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Optimal Hemodynamic Parameters for Brain-injured Patients in the Clinical Setting: A Narrative Review of the Evidence

Bebawy

2021

Journal of Neurosurgical Anesthesiology

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Defining optimal hemodynamic targets for brain-injured patients is a challenging undertaking. The physiological interference observed in various intracranial pathologies can have varying effects on cerebral physiology at different time points. This narrative review provides an overview of cerebral autoregulatory physiology and common misconceptions, and examines the physiological considerations and clinical evidence for determining optimal hemodynamic parameters in acutely brain-injured patients with relevance to modern neuroanesthesia and neurocritical care practice.

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Section: Aismentioning

confidence: 99%

Section: Aismentioning

confidence: 99%

Optimal Hemodynamic Parameters for Brain-injured Patients in the Clinical Setting: A Narrative Review of the Evidence

Bebawy

2021

Journal of Neurosurgical Anesthesiology

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Improving Regional Stroke Systems of Care

Eng

Patel

Libman

et al. 2017

Curr Atheroscler Rep

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Use of stent retrievers after selection via advanced imaging is safe and effective, and is an important option for AIS patients with large vessel occlusion (LVO). Significant time delays occur before and during patient transfers, and upon comprehensive stroke center (CSC) arrival, and have deleterious effects on functional outcome. Removing obstacles, enhancing inter-facility communication, and creating acute stroke management processes and protocols are paramount strategies to enhance network efficiency. Inter-departmental CSC collaboration can significantly reduce door-to-treatment times. Streamlined stroke systems of care may result in higher treatment rates and better functional outcomes for AIS patients, simultaneously conserving healthcare dollars. Stroke systems of care should be structured regionally to minimize time to treatment. A proactive approach must be employed; a management plan incorporating stroke team prenotification and parallel processes between departments can save valuable time, maximize brain salvage, and reduce disability from stroke.

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A system in crisis: exploring how recent emergency department closures influence potential access to emergency care in Ontario

2023

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Objectives Access to emergency medical care in Ontario has been under stress, mainly due to a lack of human resources (staffing of nurses and doctors). Over the past year, several emergency departments in Ontario have closed. Some of these closures are nightly, while others have closed for weeks at a time, leaving Ontario residents without access to emergency medical care which can lead to poor or more severe outcomes. The purpose of this paper was to examine how closures of ED’s in Ontario have influenced potential access to emergency medical care. Methods We performed population-level geographic information systems (GIS)-based analysis of potential access to ED hospitals in Ontario. The number of people with access to an ED was calculated when all ED’s in Ontario were open, then recalculated with the 14 ED closures. Access was defined by ground travel with 30 min, 45 min, and 60 min travel times used for analysis. Differences in the number of people at the census block level who potentially lost access were compiled and examined by census subdivision. Results If all 14 ED’s had closed at the same time, there would be 35,808 people at 30 min, 15,018 at 45 min, and 12,131 at 60 min travel times in Ontario who lost access to ED care. Certain areas of the province saw more significant decreases in ED access. At 45 min travel times, nearly 2000 people in Central Frontenac lost access (44% of population), while 7298 people in Cochrane (North Part) lost access (20% of population). Conclusions ED closures have led to decreases in potential access to emergency care for predominantly rural populations. Health human resource recovery strategies must focus on areas where lack of overlap exists. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-023-00460-y.

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Poor Hypertension Control and Longer Transport Times Are Associated with Worse Outcome in Drip-and-Ship Stroke Patients

Cited by 13 publications

References 18 publications

Optimal Hemodynamic Parameters for Brain-injured Patients in the Clinical Setting: A Narrative Review of the Evidence

Optimal Hemodynamic Parameters for Brain-injured Patients in the Clinical Setting: A Narrative Review of the Evidence

Improving Regional Stroke Systems of Care

A system in crisis: exploring how recent emergency department closures influence potential access to emergency care in Ontario

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