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Int J Stroke. 2018 Dec;13(9):949-984. doi: 10.1177/1747493018786616. Epub 2018 Jul 18.

Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018.

Author information

1
1 Charles-LeMoyne Hospital, Neurology, Longueuil, Quebec, Canada.
2
2 Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Quebec, Canada.
3
3 Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada.
4
4 Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
5
5 Department of Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia, Canada.
6
6 Canadian Stroke Consortium, Oakville, Ontario, Canada.
7
7 Calgary Stroke Program, Calgary, Alberta, Canada.
8
8 Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
9
9 Ottawa Stroke Program, Ottawa Hospital, Ottawa, Ontario, Canada.
10
10 workHORSE Consulting Services, London, Ontario, Canada.
11
11 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
12
12 Emergency Medical Services, Winnipeg, Manitoba, Canada.
13
13 Department of Emergency Medicine, Valley Regional Hospital, Kentville, Nova Scotia, Canada.
14
14 Vancouver General Hospital, Vancouver, British Columbia, Canada.
15
15 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
16
16 Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
17
17 Timmins & District Hospital, Timmins, Ontario, Canada.
18
18 Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
19
19 Canadian Association of Emergency Physicians, Ottawa, Ontario, Canada.
20
20 Department of Surgery, Laval University, Quebec, Canada.
21
21 Interior Health Research Department, Kelowna General Hospital, Kelowna, British Columbia, Canada.
22
22 Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
23
23 Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.
24
24 Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
25
25 Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
26
26 Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada.
27
27 Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
28
28 Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
29
29 Saint John Regional Health Centre, Saint John, New Brunswick, Canada.
30
30 University Health Network (Toronto Western Hospital) Stroke Program, Toronto, Ontario, Canada.
31
31 Vancouver Island Health Authority, Vancouver, British Columbia, Canada.
32
32 Centre hospitalier de l'université de Montréal, Montreal, Quebec, Canada.
33
33 Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
34
34 Alberta Health Services, Edmonton, Alberta, Canada.
35
35 CHU de Québec, Laval University, Laval, Quebec, Canada.
36
36 Paramedic Association of Canada, Ottawa, Ontario, Canada.
37
37 Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
38
38 University Hospital, Saskatoon, Saskatchewan, Canada.
39
39 Health Sciences Centre, St. Johns, Newfoundland, Canada.
40
40 Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.

Abstract

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider's recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

KEYWORDS:

Ischemic stroke; acute stroke therapy; acute stroke unit; acute thrombolysis; complications; early mobilization; endovascular procedures; guidelines; neurovascular imaging; palliative care

PMID:
30021503
DOI:
10.1177/1747493018786616

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