New evidence (DAWN and DEFUSE 3) indicates that highly selected patients with severe ischemic stroke may benefit from stroke Endovascular Thrombectomy (EVT) between 6-24 hours of clearly defined stroke symptom onset. In response to the extended time window, Emergency Departments and Paramedic Services collaborated with the Stroke Network of Southeastern Ontario to implement the ACT-FAST algorithm. The ACT-FAST is a large vessel occlusion screen for EVT eligibility being used to guide decision making for triaging patients arriving in the Emergency Department. The Acute Stroke Protocol is activated for patients arriving less than 6 hours from symptom onset & is now activated for ACT-FAST positive patients with new stroke symptoms arriving between 6-24 hours. Physicians and nurses commented that the use of ACT-FAST is going well and they observe less delay for walk-in activations of the Acute Stroke Protocol.Patient selection for EVT at KHSC is then based on advanced CT perfusion imaging using RAPID software. This imaging software helps quantify the amount of salvageable brain tissue using an evidence-based approach to assessing EVT eligibility based on the DEFUSE 3 and DAWN trials. KHSC-KGH site has been using RAPID imaging since January 2019 and Quinte Health Care is planning to implement RAPID imaging this fall.Although the time window has been extended for EVT, we need to remember that TIME IS BRAIN! The sooner we act the greater potential for better patient outcomes. Learn More
Fewer strokes. Better outcomes.