Abstract
Objectives: Stroke burden is especially heavy in northeast China. Facilities with the capacity to perform acute reperfusion therapies for stroke are unevenly dispersed and are especially inadequate in rural areas. The aim of this study was to establish an effective measure to improve stroke emergency care, eventually increasing the capacity for reperfusion therapy in Jilin province, a less developed province in northeast China.Methods: We created the Jilin province Stroke Emergency Maps (JSEM), a regional stroke emergency network. Qualified hospitals in Jilin province were integrated into JSEM according to strict inclusion criteria. With constant evaluation and screening, more qualified hospitals may be enrolled into the JSEM, which is updated and published once per year. Locations of hospitals with the capacity to perform intravenous thrombolysis and emergency mechanical thrombectomy were labeled on the map.Results: After strict evaluation and screening, 19 designated hospitals were integrated into the JSEM in August 2017 (baseline). Following the implementation of the JSEM, 21 more designated hospitals (40 in all) were included in 2018, and 48 more designated hospitals were included in 2019. With the guidance of the JSEM, the rate of intravenous thrombolysis in Jilin province increased remarkably from 3.3% (2017, baseline) and 4.6% (2018) to 5.5% (2019). Mean door-to-needle time decreased from 62 min at baseline (2017) to 45 min 2 years later. The number of mechanical thrombectomy was increased from 457 at baseline (2017) to 749 (2018) and 1,137 (2019) per year, respectively, and mean door-to-puncture time was shortened from 136 to 120 min.Conclusion: The JSEM, a regional stroke emergency network, serves to improve patient care for stroke. The map's publication increased rates of intravenous thrombolysis and mechanical thrombectomy. JSEM effectively connected more qualified designated hospitals, stroke patients and emergency medical service systems in Jilin province.
Highlights
Effective treatments for acute ischemic stroke rely on timely restoration of blood flow for brain tissue
This is a retrospective observational study comparing the rates of intravenous thrombolysis and mechanical thrombectomy as well as emergency medical service (EMS) system response time in Jilin province using data 1 year before (Aug 2016–July 2017), 1 year after (Aug 2017–July 2018) and 2 years after (Aug 2018–July 2019) Jilin province Stroke Emergency Maps (JSEM) project initiation
JSEM creatively developed two settings of certification criteria especially for screening hospitals qualified for intravenous thrombolysis and emergency mechanical thrombectomy according to 2018 AHA/ASA Guidelines [7]
Summary
Effective treatments for acute ischemic stroke rely on timely restoration of blood flow for brain tissue. The availability of hospitals with the capacity to perform acute reperfusion therapies for stroke patients is unevenly dispersed and is especially inadequate in rural areas [2]. With the support of the Stroke Prevention Project Committee of the Chinese National Health Commission, The China Acute Stroke Care Mapping Steering Committee was established and Acute Stroke Care Maps have been implemented in more than 40 Chinese cities. Those maps integrate prehospital emergency medical service (EMS) systems and in-hospital strategies to provide improved pathways for Chinese acute ischemic stroke patients. We aim to eventually increase the capacity of reperfusion therapy after stroke, meet the needs of stroke patients, hospitals, and the EMS system in Jilin province
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