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      Consent Issues in the Management of Acute Ischemic Stroke : AAN Position Statement

      Author(s): , , , , , on behalf of the Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society
      Publication date Created:
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      Journal: Neurology
      Publisher: Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          This position statement briefly reviews the principle of informed consent, the elements of decisional capacity, and how acute stroke may affect this capacity. It further reviews the role of surrogate decision-making, including advance directives, next of kin, physician orders for life-sustaining treatment, and guardianship. In some cases of acute stroke in which the patient lacks decisional capacity and no advance directives or surrogates are available, consent to treatment may be presumed. The document describes the rationale for this position and various considerations regarding its application to IV thrombolysis, neuroendovascular intervention, decompressive craniectomy, and pediatric stroke. The document also reviews consent issues in acute stroke research.

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          Most cited references48

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          World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

          (2013)
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            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: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

            William J. Powers, Alejandro A Rabinstein, Teri Ackerson … (2019)
            Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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              Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

              Tudor G Jovin, Raul Nogueira, Ashutosh Jadhav … (2018)
              The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy.
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                Author and article information

                Contributors
                Justin A. Sattin: (View ORCID Profile)
                Winston Chiong: (View ORCID Profile)
                Matthew P. Kirschen: (View ORCID Profile)
                Journal
                Title: Neurology
                Abbreviated Title: Neurology
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0028-3878
                ISSN (Electronic): 1526-632X
                Publication date Created: January 10 2022
                Publication date Created: January 11 2022
                Publication date (Electronic): January 10 2022
                Publication date (Print): January 11 2022
                Volume: 98
                Issue: 2
                Pages: 73-79
                Article
                DOI: 10.1212/WNL.0000000000013040
                SO-VID: 9b3d5457-12c3-40a2-b59d-dbb508ce68b1
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