Approximately 1.1 million inhabitants of Europe suffer a stroke each year. The Stroke Unit of Frankfurt University Hospital cares for 1000 acute stroke patients annually. Stroke manifests itsself with a sudden neurological deficit such as a disturbance of language and/or speech, visual disturbances, half-sided motor or sensory deficits or problems with gait and coordination. If these symptoms are not recognized as a stroke and treated adequately within a narrow time window, this can lead to persisting disability. IV thrombolysis with the clotbuster rt-PA (alteplase) doubles the chance of a life without stroke symptoms if treatment can be initiated within 90 minutes after symptom onset. And even in case of a severe stroke with large vessel occlusion, there is a 50 % chance of independent living after rehabilitative therapy if endovascular therapy is performed in a timely manner. A stroke does not have to be a stroke of fate ... if the medical teams manage to administer IV thrombolysis and endovascular stroke therapy as rapidly and safely as in the clinical trials that have proven their efficacy.
For that purpose, at Frankfurt University Hospital as in many other Stroke Units worldwide, interdisciplinary teams of neurologists, neurointerventionalists, anaesthesiologists, specialized nurses and radiology technicians operate day and night 24/7/365. To prepare this team and especially new members on the team for their interdisciplinary operations where every minute counts, senior neurologist Prof. Dr. Waltraud Pfeilschifter and head of neuro ICU nursing Peter Rostek have conceived a STROKE TEAM simulation training. Since 2012, this training has been continuously improved and led to a considerable reduction of the ‚door-to-needle’ time from the arrival of the patient to the start of the alteplase infusion with medical history, neuro-exam, brain imaging and laboratory tests. Meanwhile, the simulation concept has been adapted by the regional stroke network Interdisciplinary Neurovascular Network Rhein-Main (INVN Rhein-Main) and led to a significant reduction of the network-wide ‚door-to-needle’ time from 43 (IQR 30-60 minutes, n = 122 IVT treatments) to 31 minutes (IQR 24 to 42 minutes, n = 112) (p less than 0.001).
Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)—A Prospective Single-Arm Multicenter Trial
Bohmann FO, Kurka N, du Mesnil de Rochemont R, Gruber K, Guenther J, Rostek P, Rai H, Zickler P, Ertl M, Berlis A, Poli S, Mengel A, Ringleb P, Nagel S, Pfaff J, Wollenweber FA, Kellert L, Herzberg M, Koehler L, Haeusler KG, Alegiani A, Schubert C, Brekenfeld C, Doppler CEJ, Onur OA, Kabbasch C, Manser T, Pfeilschifter W and STREAM Trial Investigators (2019)
Front. Neurol. 10:969. (PubMed)
Tools for your stroke team: adapting crew-resource management for acute stroke care.
Willems LM, Kurka N, Bohmann F, Rostek P, Pfeilschifter W.
Pract Neurol. 2018 Aug 10. (PubMed)
A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network.
Bohmann FO, Tahtali D, Kurka N, Wagner M, You SJ, du Mesnil de Rochemont R, Berkefeld J, Hartmetz AK, Kuhlmann A, Lorenz MW, Schütz A, Kress B, Henke C, Tritt S, Meyding-Lamadé U, Steinmetz H, Pfeilschifter W.
Cerebrovasc Dis. 2018;45(3-4):141-148. (PubMed)
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide.
Tahtali D, Bohmann F, Rostek P, Wagner M, Steinmetz H, Pfeilschifter W.
J Vis Exp. 2017 Jan 15;(119). (PubMed) (Video)
Crew resource management and simulator training in acute stroke therapy.
Tahtali D, Bohmann F, Rostek P, Misselwitz B, Reihs A, Heringer F, Jahnke K, Steinmetz H, Pfeilschifter W.
Nervenarzt. 2016 Dec;87(12):1322-1331. German. (PubMed)