CLINICAL OUTCOMES OF EARLY RESUSCITATION IN ISCHEMIC STROKE
Keywords:
Key words: Ischemic Stroke, Early Resuscitation, Clinical Outcomes, Prehospital Care, Hemodynamic Management, Neuroprotection, Code Stroke, Door-to-Needle Time, Penumbra, Modified Rankin Scale (mRS).Abstract
Ischemic stroke, a leading cause of global mortality and long-term disability, represents a neurological emergency where time is brain. The efficacy of all therapeutic interventions is critically dependent on the speed and quality of initial medical care, extending beyond specific reperfusion therapies. This article provides a comprehensive analysis of the clinical outcomes associated with early, systematic resuscitation and management in the hyperacute phase of ischemic stroke. It examines the impact of optimized prehospital and emergency department care, focusing on airway and breathing management, hemodynamic optimization (permissive hypertension vs. aggressive lowering), glycemic and temperature control, and the rapid identification of large vessel occlusion (LVO). The review synthesizes evidence demonstrating that structured early resuscitation, encapsulated in the "Stroke Chain of Survival" and "Code Stroke" protocols, directly improves eligibility for and outcomes of thrombolysis and mechanical thrombectomy. Key findings indicate that every minute of delay in reperfusion results in the loss of 1.9 million neurons, making pre- and in-hospital processes pivotal. The conclusion underscores that early resuscitation is not merely supportive but a fundamental, active treatment component that preserves the ischemic penumbra, reduces infarct growth, and significantly enhances functional recovery, as measured by the modified Rankin Scale (mRS) at 90 days.
References
1. Saver, J.L. (2006). Time is Brain—Quantified. Stroke, 37(1), 263-266.
2. Pérez de la Ossa, N., et al. (2014). Design and Validation of a Prehospital Stroke Scale to Predict Large Arterial Occlusion: The Rapid Arterial Occlusion Evaluation Scale. Stroke, 45(1), 87-91.
3. Robinson, T.G., et al. (2010). Effects of Antihypertensive Treatment After Acute Stroke in the Continue Or Stop post-Stroke Antihypertensives Collaborative Study (COSSACS): A Prospective, Randomised, Open, Blinded-Endpoint Trial. The Lancet Neurology, 9(8), 767-775.
4. Lin, C.B., et al. (2012). Emergency Medical Service Hospital Prenotification Is Associated With Improved Evaluation and Treatment of Acute Ischemic Stroke. Circulation: Cardiovascular Quality and Outcomes, 5(4), 514-522.
5. Maier, I.L., et al. (2020). Blood Pressure Management After Mechanical Thrombectomy for Acute Ischemic Stroke: A Survey of the StrokeNet Sites. Journal of Stroke and Cerebrovascular Diseases, 29(2), 104459.
6. Powers, W.J., et al. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke, 50(12), e344-e418.
7. Goyal, M., et al. (2016). Endovascular Thrombectomy After Large-Vessel Ischaemic Stroke: A Meta-Analysis of Individual Patient Data From Five Randomised Trials. The Lancet, 387(10029), 1723-1731.
8. Rha, J.H., & Saver, J.L. (2007). The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis. Stroke, 38(3), 967-973.
9. Jauch, E.C., et al. (2013). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 44(3), 870-947.
10. Sandset, E.C., et al. (2021). European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. European Stroke Journal, 6(2), XLVIII-LXXXIX.
11. Lyden, P., et al. (2016). Final Results of the RHAPSODY Trial: A Multi-Center, Phase 2 Trial Using a Perfusion Imaging Biomarker to Evaluate Thiagariban in Patients With Acute Ischemic Stroke. Stroke, 47(Suppl 1), AWP107.
12. Ntaios, G., et al. (2020). Blood Pressure Management in Acute Ischemic Stroke. Current Hypertension Reports, 22(6), 43.
13. Kim, J.T., et al. (2018). Clinical Outcomes of Patients With Acute Ischemic Stroke According to the Type of Stroke Unit They Were Admitted to. Journal of Stroke, 20(2), 292-300.
14. Meretoja, A., et al. (2014). Stroke Thrombolysis: Save a Minute, Save a Day. Stroke, 45(4), 1053-1058.
15. Lees, K.R., et al. (2010). Time to Treatment With Intravenous Alteplase and Outcome in Stroke: An Updated Pooled Analysis of ECASS, ATLANTIS, NINDS, and EPITHET Trials. The Lancet, 375(9727), 1695-1703.
16. Bähr, M., et al. (2019). The Role of Normothermia in Acute Ischemic Stroke. Deutsches Ärzteblatt International, 116(19), 333-339.
17. Mishra, N.K., et al. (2011). Door-to-Imaging Time in Acute Stroke Interventions: Individual Perceptions and Institutional Policies. Stroke, 42(11), 3249-3253.
18. Nasullayev, F. O. (2024). BOLALARDA YOSHLARDA ALLERGIK OMLIKLAR, YUZAGA CHIQISH OMLIKLARI. Fan va innovatsiya , 3 (54-maxsus son), 372-374.
19. Campbell, B.C.V., et al. (2019). Penumbral Imaging and Functional Outcome in Patients With Anterior Circulation Ischaemic Stroke Treated With Endovascular Thrombectomy Versus Medical Therapy: A Meta-Analysis of Individual Patient-Level Data. The Lancet Neurology, 18(1), 46-55.
20. Karimovich, S. A. (2026). VAGINOPLASTY (COLPORRHAPHY, COLPOPLASTY)–GENERAL INFORMATION, TECHNIQUES, COMPLICATIONS. Modern education and development, 41(1), 290-296.
