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Utilization of lysis percentage via thromboelastography for tissue plasminogen activator-induced symptomatic intracranial hemorrhage
Alteplase, the only FDA approved tissue plasminogen activator (tPA), remains one of the cornerstones of acute ischemic stroke (AIS) management. Just as with endogenous tPA, recombinant tPA promotes the activation of plasmin and the subsequent degradation of cross-linked fibrin to fibrin byproducts [1]. The most feared complication of recombinant tPA administration is the development of symptomatic intracranial hemorrhage (sICH), which occurs in approximately 5.6% of tPA administrations, utilizing the European Cooperative Acute Stroke Study definition, with roughly half of these cases resulting in death [2].
Source: The American Journal of Emergency Medicine - January 16, 2021 Category: Emergency Medicine Authors: Brian W. Gilbert, J. Spencer Dingman, Joel B. Huffman Source Type: research

Effect of COVID19 on prehospital pronouncements and ED visits for stroke and myocardial infarction
In this study, our goal was to determine if there was an increase in prehospital ALS pronouncements and a decrease in ED visits for potentially serious conditions such as MI and stroke during the peak of the COVID-19 pandemic in northern NJ.
Source: The American Journal of Emergency Medicine - January 14, 2021 Category: Emergency Medicine Authors: Nikhil Jain, Michael Berkenbush, David C. Feldman, Barnet Eskin, John R. Allegra Source Type: research

Tenecteplase for thrombolysis in stroke patients: Systematic review with meta-analysis
Alteplase is an approved treatment for acute ischemic stroke. Tenecteplase is a genetically modified form of alteplase, with lower cost and a more favourable pharmacokinetic profile allowing bolus injection. The aim of this study was to compare both drugs in adult patients with acute ischemic stroke undergoing thrombolysis.
Source: The American Journal of Emergency Medicine - December 24, 2020 Category: Emergency Medicine Authors: M. Oliveira, M. Fidalgo, L. Font ão, J. Antão, S. Marques, V. Afreixo, T. Gregório Source Type: research

Risk factors for acute stroke-associated pneumonia and prediction of neutrophil-to-lymphocyte ratios
This study aimed to analyze the risk factors for stroke-associated pneumonia (SAP) and assess the predictive effect of neutrophil-to-lymphocyte ratio (NLR) on acute SAP.
Source: The American Journal of Emergency Medicine - December 19, 2020 Category: Emergency Medicine Authors: Sara M. Witcraft, Laura J. Dixon, Patric Leukel, Aaron A. Lee Source Type: research

Comments on “Inter-facility transfer for patients with acute large vessel occlusion stroke receiving mechanical thrombectomy.”
We read the recently-published article by Schevin et al. [1] with great interest. We commended the authors for looking into the work flow in Emergency Departments (ED) in patients with acute ischemia from large vessel occlusion (AIS-LVO) to assess where the longest delays to thrombectomy might occur. Unfortunately, this study is significantly underpowered to comment on patient outcomes. In this retrospective study of 95 patients undergoing mechanical thrombectomy (MT), the authors showed that patients' total ED length of stay and successful MT were not associated with good neurological outcome, defined as 90-day modified R...
Source: The American Journal of Emergency Medicine - November 25, 2020 Category: Emergency Medicine Authors: Quincy K. Tran, Nicholas Morris Source Type: research

Impact of creatinine screening on contrast-induced nephropathy following computerized tomography for stroke
This study sought to evaluate rates of acute kidney injury in patients undergoing contrast-enhanced computerized tomography for acute stroke in the emergency department (ED) before and after the cessation of creatinine screening.
Source: The American Journal of Emergency Medicine - September 18, 2020 Category: Emergency Medicine Authors: Brent A. Becker, Thomas Yeich, Jonathan T. Jaffe, Samuel Sun, Yidong Chen, Teri Rebert, Barbara A. Stahlman Source Type: research

Can non-contrast head CT and stroke severity be used for stroke triage? A population-based study
Acute ischemic stroke (AIS) patients may benefit from endovascular thrombectomy (EVT) up to 24  h since last known normal (LKN). Advanced imaging is required for patient selection. Small or rural hospitals may not have sufficient CT technician and radiology support to rapidly acquire and interpret images. We estimated transfer rates using non-contrast head CT and stroke severity to select p atients to be transferred to larger centers for evaluation.
Source: The American Journal of Emergency Medicine - August 14, 2020 Category: Emergency Medicine Authors: Charles Kircher, Amanda Humphries, Dawn Kleindorfer, Kathleen Alwell, Heidi Sucharew, Charles J. Moomaw, Jason Mackey, Felipe De Los Rios La Rosa, Brett Kissela, Opeolu Adeoye Source Type: research

Retrospective analysis of the hemodynamic consequences of prehospital supplemental oxygen in acute stroke
This study examines the hemodynamic consequences of prehospital sO2 in stroke.
Source: The American Journal of Emergency Medicine - July 9, 2020 Category: Emergency Medicine Authors: Layne Dylla, Jeremy T. Cushman, Beau Abar, Curtis Benesch, Courtney M.C. Jones, M. Kerry O'Banion, David H. Adler Source Type: research

Prehospital oxygen for stroke victims
It was of great interest to read Dr. Dylla and colleagues' well-done retrospective cohort study investigating prehospital oxygen treatment in acute stroke patients [1]. It was also very informative to read Dr. Zhang's review [2] and the authors' response [3].
Source: The American Journal of Emergency Medicine - June 8, 2020 Category: Emergency Medicine Authors: John Collins, Michael Sumner, Mehwish Barlas, Pamela Ohman Strickland, Jonathan McCoy Source Type: research

The authors respond: Studying prehospital supplemental oxygen in acute stroke
We appreciate the opportunity to respond to this letter and thank you to the author for taking time to raise these important issues regarding the potential role of prehospital supplemental oxygen (sO2) for stroke. This is an area that needs additional – including prospective – studies to better understand the potential benefits and harms of sO2 for acute stroke. In this retrospective cohort study, the Get with the Guidelines-Stroke (GWTG-S) database was used to identify adult acute stroke patients who presented to an academic Comprehensive St roke Center via EMS between January 1, 2013 and December 31, 2017.
Source: The American Journal of Emergency Medicine - February 26, 2020 Category: Emergency Medicine Source Type: research

Is prehospital supplemental oxygen effective for acute stroke?
Dr. Dylla and colleagues [1] performed a well-conducted cohort study concerning the efficacy and safety of prehospital supplemental oxygen for acute stroke. Despite the essential information provided, several issues must be resolved to draw confirmed conclusions.
Source: The American Journal of Emergency Medicine - February 23, 2020 Category: Emergency Medicine Authors: Kai Zhang Source Type: research

Prehospital Supplemental Oxygen for Acute Stroke – a Retrospective Analysis
This study examines the effects of prehospital sO2 in stroke.
Source: The American Journal of Emergency Medicine - November 17, 2019 Category: Emergency Medicine Authors: Layne Dylla, David H. Adler, Beau Abar, Curtis Benesch, Courtney MC Jones, M. Kerry O'Banion, Jeremy T Cushman Source Type: research

Comparing Pleth variability index (PVI) variation induced by passive leg raising and Trendelenburg position in healthy volunteers
Hypovolemia, which is the main cause of circulatory failure in emergency medical settings, can often be managed by volume expansion [1]. However, the fluid responsiveness (FR) varies between the patients, and volume status of the patient can be evaluated by some predictors. Studies have demonstrated that static hemodynamic measurements (e.g., central venous pressure, mean arterial pressure) were of little value in discriminating between the patients who will or will not respond to volume expansion, and dynamic indices (e.g., arterial pressure wave form, stroke volume) were more accurate in evaluating volume status [1].
Source: The American Journal of Emergency Medicine - May 6, 2019 Category: Emergency Medicine Authors: Osman L ütfi Demirci, Gülşah Çıkrıkçı Işık, Şeref Kerem Çorbacıoğlu, Yunsur Çevik Source Type: research

Throwing it in reverse: An update on reversal of oral factor Xa inhibitors
In recent years, the use of oral Factor Xa (FXa) inhibitors such as rivaroxaban and apixaban, have seen more extensive utilization for stroke prevention in non-valvular atrial fibrillation and the prevention/treatment of venous thromboembolisms [1,2]. Some studies have shown a similar bleed risk between FXa inhibitors and warfarin while other studies demonstrated a decreased risk for a bleed with FXa inhibitors. Despite a possible decreased risk, the paucity of data available for treating an acute major bleed due to FXa inhibitors has led some clinicians to shy away from their use.
Source: The American Journal of Emergency Medicine - April 7, 2019 Category: Emergency Medicine Authors: Brian W. Gilbert, Jacob A. Reeder, Mohammed A. Alkhalifah, David A. Moran, Michael A. Corvino Source Type: research

A new marker identification of high risk stroke patients: Jugular saturation
The aim of this prospective study; to investigate in emergency patients with stroke the relationship between jugular saturation and National Institutes of Health Stroke Scale (NIHSS), lesion volume and mortality score.
Source: The American Journal of Emergency Medicine - March 26, 2019 Category: Emergency Medicine Authors: Mevlut Guven, Nazire Belgin Akilli, Ramazan Koylu, Vefa Oner, Merve Guven, Muhammed Rasit Ozer Source Type: research

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