Hongjin Wang1, Arthur Thevathasan2, Richard Dowling3, Steven Bush3, Peter Mitchell4, Bernard Yan5. 1. Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, China; Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 2. Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 3. Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. 4. Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: mitchep@gmail.com. 5. Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: bernard.yan@mh.org.au.
Abstract
BACKGROUND: Recently, 5 randomized controlled trials confirmed the superiority of endovascular mechanical thrombectomy (EMT) to intravenous thrombolysis in acute ischemic stroke with large-vessel occlusion. The implication is that our health systems would witness an increasing number of patients treated with EMT. However, in-hospital delays, leading to increased time to reperfusion, are associated with poor clinical outcomes. This review outlines the in-hospital workflow of the treatment of acute ischemic stroke at a comprehensive stroke center and the lessons learned in reduction of in-hospital delays. METHODS: The in-hospital workflow for acute ischemic stroke was described from prehospital notification to femoral arterial puncture in preparation for EMT. Systematic review of literature was also performed with PubMed. RESULTS: The implementation of workflow streamlining could result in reduction of in-hospital time delays for patients who were eligible for EMT. In particular, time-critical measures, including prehospital notification, the transfer of patients from door to computed tomography (CT) room, initiation of intravenous thrombolysis in the CT room, and the mobilization of neurointervention team in parallel with thrombolysis, all contributed to reduction in time delays. CONCLUSIONS: We have identified issues resulting in in-hospital time delays and have reported possible solutions to improve workflow efficiencies. We believe that these measures may help stroke centers initiate an EMT service for eligible patients.
BACKGROUND: Recently, 5 randomized controlled trials confirmed the superiority of endovascular mechanical thrombectomy (EMT) to intravenous thrombolysis in acute ischemic stroke with large-vessel occlusion. The implication is that our health systems would witness an increasing number of patients treated with EMT. However, in-hospital delays, leading to increased time to reperfusion, are associated with poor clinical outcomes. This review outlines the in-hospital workflow of the treatment of acute ischemic stroke at a comprehensive stroke center and the lessons learned in reduction of in-hospital delays. METHODS: The in-hospital workflow for acute ischemic stroke was described from prehospital notification to femoral arterial puncture in preparation for EMT. Systematic review of literature was also performed with PubMed. RESULTS: The implementation of workflow streamlining could result in reduction of in-hospital time delays for patients who were eligible for EMT. In particular, time-critical measures, including prehospital notification, the transfer of patients from door to computed tomography (CT) room, initiation of intravenous thrombolysis in the CT room, and the mobilization of neurointervention team in parallel with thrombolysis, all contributed to reduction in time delays. CONCLUSIONS: We have identified issues resulting in in-hospital time delays and have reported possible solutions to improve workflow efficiencies. We believe that these measures may help stroke centers initiate an EMT service for eligible patients.
Authors: Silvia Schönenberger; Dorothea Weber; Matthias N Ungerer; Johannes Pfaff; Simon Schieber; Lorenz Uhlmann; Pia Heidenreich; Martin Bendszus; Meinhard Kieser; Wolfgang Wick; Markus A Möhlenbruch; Peter A Ringleb; Julian Bösel Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210
Authors: David C Lauzier; Maria M Galardi; Kristin P Guilliams; Manu S Goyal; Catherine Amlie-Lefond; Danial K Hallam; Akash P Kansagra Journal: Stroke Date: 2021-03-11 Impact factor: 7.914