An evaluation of a newly implemented stroke team activation protocol in Manitoba

The purpose of this study was to evaluate a revised stroke 25 protocol in Manitoba, which integrated Stroke Team Activation by the Virtual Emergency Care and Transfer Resource Service (VECTRS), and to determine whether its implementation reduced time to acute stroke treatment compared to the previous protocol. This retrospective chart review utilized Emergency Medical Services (EMS) data from the Winnipeg Fire Paramedic Service (WFPS) and hospital electronic medical records from the Winnipeg Health Sciences Centre (HSC), comparing 12 months before and 12 months after implementation of the revised Stroke 25 protocol. For each patient, the interval from EMS arrival at HSC to initiation of acute stroke treatment was calculated. Mean times to thrombolysis and EVT were compared between pre- and post-implementation cohorts. In the pre-intervention cohort, 757 patients with suspected stroke were triaged to HSC, of whom 131 received Alteplase or Tenecteplase (TNK) and 33 underwent EVT. In the post- intervention group, 717 patients were triaged, with 110 receiving Alteplase/TNK and 30 undergoing endovascular thrombectomy (EVT). Mean time to thrombolysis decreased from 59.1 min pre- intervention to 52.8 min post- intervention, while mean time to EVT decreased from 92.2 min to 84.1 min, respectively. Implementation of the revised Stroke 25 protocol was associated with modest reductions in absolute time to treatment for patients with acute ischemic stroke; however, while these differences were not statistically significant, the impact for these patients may still be clinically significant.