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Clinical and Translational Neuroscience is published by MDPI from Volume 5 Issue 2 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with SAGE.
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Guidelines

Swiss Guidelines for the Prehospital Phase in Suspected Acute Stroke

by
Georg Kägi
1,*,
David Schurter
2,
Julien Niederhäuser
3,
Gian Marco De Marchis
4,
Stefan Engelter
4,5,
Patrick Arni
6,
Olivier Nyenhuis
7,
Paul Imboden
8,
Christophe Bonvin
9,
Andreas Luft
10,
Susanne Renaud
11,
Krassen Nedeltchev
12,
Emmanuel Carrera
13,
Carlo Cereda
14,
Urs Fischer
15,
Marcel Arnold
15 and
Patrik Michel
16,*
1
Department of Neurology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
2
Protection & Rescue Zurich, Ambulance, Zurich, Switzerland
3
Stroke Unit, Groupement Hospitalier de l’Ouest Lémanique, 1260 Nyon, Switzerland
4
Department of Neurology and Stroke Centre, University Hospital Basel, 4031 Basel, Switzerland
5
Neurorehabilitation Felix Platter, University of Basel, 4001 Basel, Switzerland
6
Protection and Rescue Bern, Medical Police, Bern, Switzerland
7
Inter Association of Rescue Services, Bern, Switzerland
8
Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, Kantonsspital St. Gallen, Switzerland
9
Division of Neurology and Stroke Unit, Hôpital du Valais, 1950 Sion, Switzerland
10
Department of Neurology, University Hospital Zurich and Cereneo, 6354 Vitznau, Switzerland
11
Division of Neurology, Neuchâtel Hospital Network, 2000 Neuchâtel, Switzerland
12
Department of Neurology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
13
Department of Neurology, University Hospitals of Geneva, 1205 Geneva, Switzerland
14
Department of Neurology, Neurocentro della Svizzera Italiana, Lugano Civic Hospital, 6900 Lugano, Switzerland
15
Department of Neurology, Inselspital Bern and University of Bern, 3010 Bern, Switzerland
16
Department of Neurology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
 
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*
Authors to whom correspondence should be addressed.
Clin. Transl. Neurosci. 2021, 5(1), 10; https://doi.org/10.1177/2514183x21999230
Submission received: 13 January 2021 / Accepted: 11 February 2021 / Published: 22 April 2021
Versions Notes

Abstract

Acute stroke treatment has advanced substantially over the last years. Important milestones constitute intravenous thrombolysis, endovascular therapy (EVT), and treatment of stroke patients in dedicated units (stroke units). At present in Switzerland there are 13 certified stroke units and 10 certified EVT-capable stroke centers. Emerging challenges for the prehospital pathways are that (i) acute stroke treatment remains very time sensitive, (ii) the time window for acute stroke treatment has opened up to 24 h in selected cases, and (iii) EVT is only available in stroke centers. The goal of the current guideline is to standardize the prehospital phase of patients with acute stroke for them to receive the optimal treatment without unnecessary delays. Different prehospital models exist. For patients with large vessel occlusion (LVO), the Drip and Ship model is the most commonly used in Switzerland. This model is challenged by the Mothership model where stroke patients with suspected LVO are directly transferred to the stroke center. This latter model is only effective if there is an accurate triage by paramedics, hence the patient may benefit from the right treatment in the right place, without loss of time. Although the Cincinnati Prehospital Stroke Scale is a well-established scale to detect acute stroke in the prehospital setting, it neglects nonmotor symptoms like visual impairment or severe vertigo. Therefore we suggest “acute occurrence of a focal neurological deficit” as the trigger to enter the acute stroke pathway. For the triage whether a patient has a LVO (yes/no), there are a number of scores published. Accuracy of these scores is borderline. Nevertheless, applying the Rapid Arterial Occlusion Evaluation score or a comparable score to recognize patients with LVO may help to speed up and triage prehospital pathways. Ultimately, the decision of which model to use in which stroke network will depend on local (e.g., geographical) characteristics.
Keywords: stroke; prehospital; guidelines; Swiss; large vessel occlusion stroke; prehospital; guidelines; Swiss; large vessel occlusion

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MDPI and ACS Style

Kägi, G.; Schurter, D.; Niederhäuser, J.; De Marchis, G.M.; Engelter, S.; Arni, P.; Nyenhuis, O.; Imboden, P.; Bonvin, C.; Luft, A.; et al. Swiss Guidelines for the Prehospital Phase in Suspected Acute Stroke. Clin. Transl. Neurosci. 2021, 5, 10. https://doi.org/10.1177/2514183x21999230

AMA Style

Kägi G, Schurter D, Niederhäuser J, De Marchis GM, Engelter S, Arni P, Nyenhuis O, Imboden P, Bonvin C, Luft A, et al. Swiss Guidelines for the Prehospital Phase in Suspected Acute Stroke. Clinical and Translational Neuroscience. 2021; 5(1):10. https://doi.org/10.1177/2514183x21999230

Chicago/Turabian Style

Kägi, Georg, David Schurter, Julien Niederhäuser, Gian Marco De Marchis, Stefan Engelter, Patrick Arni, Olivier Nyenhuis, Paul Imboden, Christophe Bonvin, Andreas Luft, and et al. 2021. "Swiss Guidelines for the Prehospital Phase in Suspected Acute Stroke" Clinical and Translational Neuroscience 5, no. 1: 10. https://doi.org/10.1177/2514183x21999230

APA Style

Kägi, G., Schurter, D., Niederhäuser, J., De Marchis, G. M., Engelter, S., Arni, P., Nyenhuis, O., Imboden, P., Bonvin, C., Luft, A., Renaud, S., Nedeltchev, K., Carrera, E., Cereda, C., Fischer, U., Arnold, M., & Michel, P. (2021). Swiss Guidelines for the Prehospital Phase in Suspected Acute Stroke. Clinical and Translational Neuroscience, 5(1), 10. https://doi.org/10.1177/2514183x21999230

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