Since your study validates the efficacy on MRI based on patients having similar outcomes after TPA when comparing MRI versus CT, and the literature already shows that statistically TPA does not improve patient outcomes, I think the critical thinker could easily extrapolate that TPA outcome is not a relevant indicator of MRI efficacy.
IFT Post stroke pt - does ems need to get tpa administration time?
- Thread starter mrhunt
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Since your study validates the efficacy on MRI based on patients having similar outcomes after TPA when comparing MRI versus CT, and the literature already shows that statistically TPA does not improve patient outcomes, I think the critical thinker could easily extrapolate that TPA outcome is not a relevant indicator of MRI efficacy.
The trial itself has nothing to do with tPA. Its a post hoc analysis of the THRACE trial (tPA vs tPA + thrombectomy) demonstrating that MRI doesn't delay time to treatment. Which contrasts your statement "The time that a MRA takes delays the start of TPA infusion or time to needle for PCI."
VFlutter
Flight Nurse
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Unless you can't get me to a thrombectomy center within 12-24hrs, don't give me tPA. In our area tPA is falling out of favor and the treatment paradigm is primary mechanical retrieval or catheter directed tPA out to 24hrs
I doesn't though. It demonstrated in a statistically small group of patients who happened to have the essentially same timeline in a nonblinded study. Despite having a small number of patients it showed the CT cohort to be far more comorbid. It shows an average CT duration of 9 minutes, which is far longer than reasonable. They admit that the CT patients took 15 minutes longer after CT to receive TPA, which there is no real discussion of what the delay was. There is no discussion of what the MRI scanners or CT scanners actually are, since duration is very long for CT and short for MR I would presume the CTs were old and the MRI was new and high power.
"Our study has several limitations. (1) The THRACE trial was not designed for the purpose of the current study and randomization was not stratified on imaging modality. As a consequence, the choice of imaging modality may have depended on confounding variables. For instance, in centers using MRI as a prime screening imaging modality in stroke patients, the most severely ill patients might be directed towards CT."
Im sorry but this isn't a real study. It's essentially a case study.
Find a modern trial that demonstrates the MRI delays time to intervention. And while you're at it, maybe the research that shows that perfusion and diffusion MRI sequences is inferior to CT at identifying early ischemic penumbra...
Believe it or not there are not studies on possible question.
MR Hunt; this thread got way off the original questions; which they seem to do a lot; which we can learn from, but sometimes is a little annoying.
Learn from this; anytime you are transferring a patient, try to get times that medications were started and ended (or if they are continuing during transport, what time they should end). You may not need it for the nurse at the receiving hospital, but if you have to call in because your patient is crashing, it might help.
Also when you get to the receiving hospital, remember that the nurse that took the report may not be the one receiving the patient, so they may not have the notes from the transferring hospital; so if you have that information it will help them out.
Good luck, enjoy and keep asking questions, because it will help you and your patients (and drive people crazy on here).
Learn from this; anytime you are transferring a patient, try to get times that medications were started and ended (or if they are continuing during transport, what time they should end). You may not need it for the nurse at the receiving hospital, but if you have to call in because your patient is crashing, it might help.
Also when you get to the receiving hospital, remember that the nurse that took the report may not be the one receiving the patient, so they may not have the notes from the transferring hospital; so if you have that information it will help them out.
Good luck, enjoy and keep asking questions, because it will help you and your patients (and drive people crazy on here).