Management of Stroke with Pharmacological Fibrinolysis in an Emergency Department at a Level 2 Hospital in Central Ecuador

Introduction: A timely and organized response in the emergency department is crucial for the treatment of stroke with pharmacological fibrinolysis. Currently, few stroke patients have access to fibrinolytic treatment in Ecuador, as most hospitals lack a well-coordinated stroke response. This remains true at even the highest acuity (level 3) hospitals. In this study we report the initial results of the first code stroke and fibrinolysis pathway established in a level 2 public hospital in a small city (pop 300,000) in Ecuador.Objective: To develop an organized and coordinated pathway within the hospital for the correct diagnosis and treatment of patients with clinical presentation of stroke, starting with early identification of signs/symptoms and the activation of a specific pathway, which in turn improves the prognosis and the quality of life of acute ischemic stroke patients.Methods: This was a prospective, longitudinal, descriptive study of patients presenting with stroke symptoms, for whom a code stroke and red triage priority was applied in the emergency department of Hospital General Docente Ambato in the first three months of 2019. To be eligible for thrombolysis, patients had to arrive within 4.5 hours of symptom onset and not have any contraindications to thrombolysis.Results: 30 patients arrived at the emergency department with stroke symptoms, and in each case a code stroke was activated upon arrival to the emergency department. The mean age of patients was 66.63 years, and 15 patients were male (50%). 19 patients (63%) arrived within 4.5 hours of symptom onset, of which 8 patients (42%) had no contraindication and received thrombolysis. The mean door-to-needle time was 66 minutes.Conclusions: This study demonstrates that it is feasible to establish a code stroke and fibrinolysis treatment pathway in level 2 hospitals in Ecuador. Many other hospitals in the country could establish similar treatment protocols and improve their management of ischemic stroke patients