Introduction. Systemic thrombolytic therapy with recombinant tissue plasminogen activator is the only reperfusion method available to most primary vascular units which allows significantly improving the functional prognosis of patients with ischemic stroke.
Objective. To analyze the main determinants limiting reperfusion therapy administration in a subsidized region with demographic aging of the population, and to develop and scientifically justify the ways of their elimination.
Materials and methods. We analyzed the data of the ambulance station in Smolensk electronic archive accounting for 17,143 phone requests for medical aid for patients with strokes, the data from the annual report of the neurological department for patients with acute cerebrovascular accident of the Clinical emergency care hospital, and 200 clinical records of patients diagnosed with acute stroke that were delivered to the in-patient facility by emergency medical service (EMS) teams in the period of the “therapeutic window” and who did not receive reperfusion therapy. The operative work of the dispatcher service, the efficiency of the mobile teams work, the structure of time losses during the call service, and the distribution of patients by the time period before the admission to a hospital depending on the way of admission and the remoteness of the “zone of responsibility” from the primary vascular surgery department were assessed.
Results. It was found that statistically significant differences in time period before admission to a hospital of patients with ischemic strokes depend on the admission way and, in the case of arrival by the EMC, do not depend on the distance of the delivery area. The low efficiency of the mobile teams is due to the imperfection of call processing by dispatchers and the lack of a systematic approach and a single algorithm aimed for diagnosing and providing emergency assistance to the medical personnel of EMS teams. The main non-regulating factors for abandoning systemic administration of the recombinant tissue plasminogen activator in patients with ischemic strokes delivered to the hospital in the period of the “therapeutic window” are mild neurological symptoms, the age over 80 years and poly-morbidity of patients.
Conclusion. It is necessary to adopt a series of measures aimed at advancing the efficiency of the EMS teams and rising awareness within the general public in order to reduce mortality of patients with ischemic strokes through increasing frequency of reperfusion therapy administration.
Piradov M.A., Tanashyan M.M. (Eds.) [Stroke academy: documents of the School of the Research center of neurology of the cerebral vascular disorders]. Moscow; 2015. 175 p. (In Russ.)
Alekseev M.A. [Hospitalized morbidity, characteristics of mortality associated with cerebral vascular disorders of the able-bodied citizens and development of the organizational measures to decrease them]. Social aspects of the health of the population 2015; 45(5). (In Russ.)
Gusev E.I., Skvortsova V.I., Stakhovskaya L.V. [The problem of the stroke in the Russian Federation: time of the active cooperation]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova 2007; (8): 4–10. (In Russ.)
Shepotinnik E.V. [Optimization of the time losses of the patients with acute cerebral circulation disorders at the pre-hospital and hospital stage]. Mezhdunarodnyy nevrologicheskiy zhurnal 2012; (2): 167–170. (In Russ.)
Jauch E.C., Saver J.L., Adams H.P. 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. DOI: 10.1161/STR.0b013e318284056a. PMID: 23370205.
Kotov S.V., Isakova E.V., Belova Yu.A. et al. [Cerebrovascular morbidity and mortality among the senior citizens of the Moscow region in 2015]. Klinicheskaya gerontologiya 2016; (9–10): 40–41. (In Russ.)
Stakhovskaya L.V., Shekhovtsova K.V., Rojkova T.I. et al. [Comparative analysis of the quality of the medical care to the stroke patients at the pre-hospital stage in different cities of the Russian Federation]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova 2010; 9(2): 36–41. (In Russ.)
Audebert H.J., Saver J.L., Starkman S. et al. Prehospital stroke care: new prospects for treatment and clinical research. Neurology 2013; 81: 501–508. DOI: 10.1212/WNL.0b013e31829e0fdd. PMID: 23897876.
Berglund A., Euler M., Schenck-Gustafsson K. et al. Identification of stroke during the emergency call: a descriptive study of callers presentation of stroke. BMJ Open 2015; 5(4). DOI: 10.1136/bmjopen-2015-007661. PMID: 25922106.