Question#: 645

Question:

Hi, I have a question regarding the acute stroke bypass, directly relating to an onset of greater than 6 hours. In my interpretation of the directive these patients are not to be transported on an acute stroke bypass and instead to be taken to the closest facility. I recently transported a patient who fell out of the stroke bypass in this same scenario. At the closest hospital the physician stated the hospitals are now sending patients with an onset of less than 24 hours to a stroke center. The physician consulted with neurology at the stroke center and we ended up taking this patient to the stroke center on an interfacility transfer. This took over 30 minutes to arrange, not including the additional travel . If neurology still wants to see these patient Should this not be changed in the directives or perhaps changed to a mandatory patch point for consultation ?



Any information would be appreciated

I was around when this bypass was extended from 4 hours to 6

Thank you



Koty Gorman

Answer:

Thank you for your MedicASK submission regarding stroke bypass and time of onset.

This is a great question and could not have come at a better time as there is new science and evidence evolving faster than the guidelines can keep up with. You will likely see changes to bypass agreements/stroke cards in the near future however, for now it is encouraged that you patch to discuss an alternative destination with one of the BHP's. The key point specific to the 6-24 hour stroke patient, is that the patient must screen positive for LVO (greater or equal to 4) using a LAMS score. It is not for all stroke patients within 24 hours.

I encourage you to read the attached article (which is published in the current MedicNEWS and can also be round on the RPPEO website - scroll down to the bottom) by Dr. Froats on "Time is Brain" as he explains in depth acute ischemic strokes (AIS), with a LAMS score of greater of equal to 4, who present 6-12 hours after last seen normal, and how these patient's are an emergency and may be eligible for endovascular therapy (EVT).

Hope this helps!

Please don't hesitate to reach out should you have any further questions/concerns.

Stay safe!

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