I didn't think that stroke thrombolysis was really life-saving, but has been
shown to improve morbidity and functional outcome. The mortality is similar
at the end of the day.
I've been in 2 institutions during the setting-up phase and both started off
office hours initially. I know one has moved to 24/7 but I don't predict
that the other ever will. In my current post we do office hours in-house
but transfer to another facility out of hours as our stroke consultant is on
the thrombolysis rota there.
We've extended out to 4.5 hours but the majority would be around the 3 hour
mark. It's very resource-intensive and it's only a single consultant in
this hospital who thrombolysis. The decision is only at consultant-level
and access to CT remains a big stumbling block.
Stroke thrombolysis is and will remain a consultant-delivered service,
delivered by a small subset with an interest. The ED staff facilitate the
process.
As for primary PCI, all this is done off-site to the same institution 24/7
and I haven't had to 'lyse someone in the past 7 months despite having 2
STEMIs to go across town at 03:30 and 4am one night!
J
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-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Craig Ellis
Sent: 03 February 2011 21:37
To: [log in to unmask]
Subject: Re: Stroke thrombolysis
Assuming you support it the first place. How is it ethical to only offer a
service like this 9-5? If it is truly 'life saving' surely it irresponsible
Press would have a field day.
Why can't ED initiate this 24/7.
Not criticism just curious.
Craig
On 4/02/2011, at 5:14 AM, "Andy Webster"
<[log in to unmask]<mailto:[log in to unmask]>> wrote:
Our local stroke network wishes to implement the findings of ECASS 3 to
extend the thrombolysis window to 4.5 hours. What are colleagues doing
locally? If thrombolysing strokes at all.
So far in four months on a 9-5 service we have managed to thrombolyse 2. Don’t
think we are missing many eligible ones just in a rural population they seem
to be arriving to late.
Andy Webster
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