Endovascular Thrombectomy (EVT) Steering Committee and Telestroke Update

The Endovascular Thrombectomy (EVT) Steering Committee will be expanding its role and purpose to include guidance and direction for the Ontario Telestroke Program. This transition recognizes the critical infrastructure that Telestroke provides in the delivery of acute stroke care in more rural and remote areas of the province that do not have access to stroke neurology services. In addition to supporting administration of thrombolysis, Telestroke neurologists provide consultation and selection of potential candidates for EVT.

The Stroke Leadership Council approved the proposal to expand the role in October and will result in a name change to the Hyperacute Stroke Steering Committee. This committee will now provide advice and help facilitate decision making that can support a coordinated approach for:

• resource allocation;
• planning and implementation of processes for equitable access to hyperacute stroke treatment;
• ensuring alignment to best practice;
• monitoring performance; and
• promoting quality improvement at provincial and regional levels.

On September 3, changes to the Paramedic Prompt Card for Acute Stroke Bypass Protocol came into force. This allowed emergency medical services (EMS) to determine transport to the closest or most appropriate Designated Stroke Centre.

To support emergency health personnel to make decisions regarding the most appropriate transport destination for acute stroke patients, CorHealth Ontario’s Endovascular Thrombectomy (EVT) Steering Committee made some recommendations to the Ontario Base Hospital Medical Advisory Committee:

• A provincial adoption of the Los Angeles Motor Scale (LAMS) as a secondary screen to identify patients who may most benefit from EVT and direct transport to an EVT Centre (i.e. patients experiencing large vessel occlusion stroke)

Implementation of the redirect model will be geography dependent for each stroke region, but will provide an opportunity to increase access to EVT to further optimize patient outcomes, when feasible.

Final approval on the LAMS tool, as part of the Basic Life Support Patient Care Standard, is still pending upon the Emergency Health Services Branch of the Ministry of Health’s approval.