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.
| Original language | English |
|---|---|
| Pages (from-to) | 949-984 |
| Number of pages | 36 |
| Journal | International Journal of Stroke |
| Volume | 13 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
Bibliographical note
Funding Information:The development of the Canadian Stroke Best Practice Recommendations is funded in its entirety by the Heart and Stroke Foundation, Canada. No funds for the development of these guidelines are received from commercial interests, including pharmaceutical and medical device companies. All members of the recommendation writing groups and external reviewers are volunteers and do not receive any remuneration for participation in guideline development, updates and reviews. All participants complete a conflict of interest declaration prior to participation and these are disclosed in Appendix 1.
Funding Information:
Heart and Stroke gratefully acknowledges the Acute Stroke Management writing group leaders and members all of whom have volunteered their time and expertise to the update of these recommendations. Members of the Canadian Stroke Consortium were involved in all aspects of the development of these recommendations. Members of the Canadian Association of Emergency Physicians were involved in the development of recommendations relevant to their practice, and included Alix Carter, Crystal Doyle, Charles Duffy, Nadder Sharif, Kevin Lobay, Bilal Mir, Amani Otoom, Jeffrey J Perry, Anthony Shearing, and Etienne van der Linde. We acknowledge and thank Randy Mellow, President, and Kelly Nash, Executive Director of the Paramedic Chiefs of Canada, and their members who collaborated, reviewed, and provided suggestions for this document. Jeffrey Myers and Moira Teed provided review for sections of this module. Mayank Goyal and Bijoy Menon provided input on early drafts of the recommendations. Norine Foley, Sanjit Bhogal, and the evidence analysis team at workHORSE provided all evidence extraction and synthesis. These recommendations underwent external review by Marie-Christine Camden, Adrian Fawcett, Neala Gill, M Shazam Hussain, Pooja Khatri, Timo Krings, Ariane Mackey, Antonia Nucera, Rhonda McNicoll?Whiteman, Thanh Nguyen, Catherine Patocka, Jeremy Rempel, Danielle Roy, Sean Sopher, Joseph Silvaggio, and Neil E Schwartz. These recommendations were reviewed and approved by the Heart & Stroke Canadian Stroke Best Practices and Stroke Quality Advisory Committee members, including Eric Smith, Ed Harrison, Robert Cote, Andrew Demchuk, Denyse Richardson, Alexandre Poppe, Moira Kapral, Farrell Leibovitch, Christine Papoushek, Alan Bell, Barbara Campbell, Cassie Chisholm, Hillel Finestone, Dwayne Forsman, Devin Harris, Michael Hill, Thomas Jeerakathil, Michael Kelly, Noreen Kamal, Eddy Lang, Beth Linkewich, Colleen O?Connell, Jai Shankar, Mike Sharma, Dawn Tymianski, Katie White, and Samuel Yip. Support and contributions to the development and publication of these recommendations was provided by internal Heart and Stroke teams including communications, translation, knowledge exchange, promote recovery, health policy, and digital technology.
Funding Information:
JM Boulanger is a speaker for Bayer and Pfizer; G Gubitz is a speaker for Bayer, Boehringer Ingelheim, and BMS Pfizer; C O’Kelly is a course instructor for Medtronic; D Blacquiere is a speaker for Bayer; LK Casaubon is a speaker and advisory committee member for Bayer and Covidien Canada, an independent neurological assessor for Medtronic, and a site principal investigator for NoNO; M Kelly is a speaker for Penumbra, and a proctor for Medtronic; K Butcher is a speaker for Bayer, Boehringer Ingelheim, and BMS Pfizer, and had received research funding from Bayer and Boehringer Ingelheim. The following authors do not have any conflicts of interest to declare with respect to this manuscript: Lindsay MP, Stotts G, Smith EE, Foley N, Bhogal S, Boyle K, Braun L, Goddard T, Heran MKS, Kanya-Forster N, Lang E, Lavoie P, McClelland M, Pageau P, Pettersen J, Purvis H, Shamy M, Tampieri D, vanAdel B, Verbeek R, Ferguson D, Hegedus Y, Jacquin GJ, Linkewich B, Lum C, Mann B, Milot G, Newcommon N, Poirier P, Simpkin W, Snieder E, Kamal N, Trivedi A, Whelan R, and Smitko E.
Publisher Copyright:
© 2018 World Stroke Organization.
ASJC Scopus Subject Areas
- Neurology