Skip to main content

Advertisement

Log in

Emergency Neurological Life Support: Acute Ischemic Stroke

  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Acute ischemic stroke is a neurological emergency that can be treated with time-sensitive interventions, including both intravenous thrombolysis and endovascular approaches to thrombus removal. Extensive study has demonstrated that rapid, protocolized, assessment and treatment is essential to improving neurological outcome. For this reason, acute ischemic stroke was chosen as an emergency neurological life support protocol. The protocol focuses on the first hour of medical care following the acute onset of a neurological deficit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. The top 10 causes of death: fact sheet, World Health Organization. 2017. http://www.who.int/mediacentre/factsheets/fs310/en/.

  2. Benjamin EJ, Blaha MJ, Chiuve SE. Heart disease and stroke statistics—2017 update a report from the American Heart Association. Circulation. 2017;135:00–00. http://circ.ahajournals.org/content/early/2017/01/25/CIR.0000000000000485.

  3. Higashida R, et al. Interactions within stroke systems of care: a policy statment from the American Heart Association/American Stroke Association. Stroke. 2013;44:2961–84.

    Article  PubMed  Google Scholar 

  4. Jauch EC, et al. Guidelines for the Early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.

    Article  PubMed  Google Scholar 

  5. Telestroke guidelines. American Telemedicine Association (pending release as of March 2017).

  6. Schwamm, LH, et al. Recommendations for the implementation of telehealth in cardiovascular and stroke care. A policy statement from the American Heart Association. Circulation 2017;135:00-00. http://circ.ahajournals.org/content/early/2016/12/20/CIR.0000000000000475.

  7. Wechsler LR, et al. Telemedicine quality and outcomes in stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48:e3–25.

    Article  PubMed  Google Scholar 

  8. Thomalla G, et al. A multicenter, randomized, double-blind, placebo-controlled trial to test efficacy and safety of magnetic resonance imaging-based thrombolysis in wake-up stroke (WAKE_UP). Int J Stroke. 2014;9(6):829–36.

    Article  PubMed  Google Scholar 

  9. Koga M, et al. Thrombolysis for acute wake-up and unclear-onset strokes with alteplase at 0.6 mg/kg (THAWS) trial. Int J Stroke. 2014;9(8):1117–24.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Barreto AD, et al. Prospective, open label safety study of intravenous recombinent tissue plasminogen activator in wake-up stroke. Ann Neurol. 2016;80:211–8.

    Article  CAS  PubMed  Google Scholar 

  11. Smith EE, et al. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator. Stroke. 2011;42:3110–5.

    Article  CAS  PubMed  Google Scholar 

  12. The NINDS t-PA Stroke Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic. Stroke. 1997;28:2109–18.

    Article  Google Scholar 

  13. Daemaerschalk BM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke. Stroke. 2016;47:581–641.

    Article  Google Scholar 

  14. Hacke W, et al. Thrombolysis with alteplase 3–4.5 h after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.

    Article  CAS  PubMed  Google Scholar 

  15. Summers D, et al. Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: a scientific statement from the American Heart Association. Stroke. 2009;40(8):2911–44.

    Article  PubMed  Google Scholar 

  16. Yaghi S, et al. Treatment and outcome of thrombolysis-related hemorrhage: a multicenter retrospective study. JAMA Neurol. 2015;72(12):1451–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Furlan A, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. prolyse in acute cerebral thromboembolism. JAMA. 1999;282:2003–11.

    Article  CAS  PubMed  Google Scholar 

  18. Ogawa A, et al. Randomized trial of intraarterial infusion of urokinase within 6 h of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (melt) Japan. Stroke. 2007;38:2633–9.

    Article  CAS  PubMed  Google Scholar 

  19. Berkhemer OA, et al. A randomized trial of intraarterial treatment for acute ischemic stroke [MR CLEAN]. N Engl J Med. 2015;372:11–20.

    Article  PubMed  Google Scholar 

  20. Campbell BC, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection [EXTEND-IA]. N Engl J Med. 2015;372:1009–18.

    Article  CAS  PubMed  Google Scholar 

  21. Goyal M, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke [ESCAPE]. N Engl J Med. 2015;372:1019–30.

    Article  CAS  PubMed  Google Scholar 

  22. Jovin TG, et al. Thrombectomy within 8 h after symptom onset in ischemic stroke [REVASCAT]. N Engl J Med. 2015;372:2296–306.

    Article  CAS  PubMed  Google Scholar 

  23. Saver JL, et al. Stent-retriever thrombectomy after intravenous t-PA versus t-PA alone in stroke [SWIFT PRIME]. N Engl J Med. 2015;372:2285–95.

    Article  CAS  PubMed  Google Scholar 

  24. Powers WJ, et al. 2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke. 2015;46:3020–35.

    Article  CAS  PubMed  Google Scholar 

  25. Anderson CS. Presentation at international stroke conference 2017, Houston, Texas. Feb 2017.

  26. Wijdicks E, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling. Stroke. 2014;45:1222–38.

    Article  PubMed  Google Scholar 

  27. Fullerton HJ, et al. Risk of stroke in children: ethnic and gender disparities. Neurology. 2003;61:189–94.

    Article  PubMed  Google Scholar 

  28. Giroud M, et al. Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol. 1995;48:1343–8.

    Article  CAS  PubMed  Google Scholar 

  29. Mallick AA, et al. Childhood arterial ischemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014;13:35–43.

    Article  PubMed  Google Scholar 

  30. Mackay MT, et al. Stroke and nonstroke brain attacks in children. Neurology. 2014;82:1434–40.

    Article  PubMed  Google Scholar 

  31. Ichord RN, et al. Interrater reliability of the pediatric national institutes of health stroke scale (PEDNIHSS) in a multicenter study. Stroke. 2011;42:613–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Rivkin MJ, et al. Thrombolysis in pediatric stroke study. Stroke. 2015;46:880–5.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Adams RJ, et al. Prevention of first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339:5–11.

    Article  CAS  PubMed  Google Scholar 

  34. Easton JD, et al. Definition and evaluation of transient ischemic attack. Stroke. 2009;40:2276–93.

    Article  PubMed  Google Scholar 

  35. Cucchiara B, Ross M. Transient ischemic attack: risk stratification and treatment. Ann Emerg Med. 2008;52:S27–39.

    Article  PubMed  Google Scholar 

  36. Kennedy J, et al. Fast assessment of stroke and transient ischemic attack to prevent early recurrence (FASTER): a randomized controlled pilot trial. Lancet Neurol. 2007;6:961–9.

    Article  CAS  PubMed  Google Scholar 

  37. Stone NJ, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;129:S1–45.

    Article  PubMed  Google Scholar 

  38. Lip GY, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest. 2010;137:263–72.

    Article  PubMed  Google Scholar 

  39. Pisters R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  PubMed  Google Scholar 

  40. Bruce N, et al. Medico-legal aspects of using tissue plasminogen activator in acute ischemic stroke. Curr Treat Options Cardiovasc Med. 2011;13:233–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bhatt A, et al. Medicolegal considerations with intravenous tissue plasminogen activator in stroke: a systematic review. Stroke Research and Treatment. 2013; Article ID 562564. http://dx.doi.org/10.1155/2013/562564.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hartmut Gross.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gross, H., Grose, N. Emergency Neurological Life Support: Acute Ischemic Stroke. Neurocrit Care 27 (Suppl 1), 102–115 (2017). https://doi.org/10.1007/s12028-017-0449-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-017-0449-9

Keywords

Navigation