Pre-hospital and intrahospital workflow optimization for patients with suspected ischemic stroke due to large vessel occlusion-findings from a tertiary care facility

被引：4

作者：

Krebs, Stefan ^{[1
]}

Ferrari, Julia ^{[1
]}

Schuerer, Alice ^{[2
]}

Chiari, Astrid ^{[3
]}

Neumann, Christian ^{[4
]}

Lang, Wilfried ^{[1
,2
]}

Sykora, Marek ^{[1
,2
]}

机构：

[1] St Johns Hosp, Dept Neurol, Johannes Von Gott Pl 1, A-1020 Vienna, Austria

[2] Sigmund Freud Univ, Med Fac, Vienna, Austria

[3] St Johns Hosp, Dept Anesthesiol, Vienna, Austria

[4] St Johns Hosp, Dept Radiol, Vienna, Austria

来源：

BMC NEUROLOGY | 2022年 / 22卷 / 01期

关键词：

LVO; Mechanical thrombectomy; Ischaemic stroke; Workflow; EARLY MANAGEMENT; 2018; GUIDELINES; THROMBECTOMY; PROFESSIONALS; SEDATION; THERAPY;

D O I：

10.1186/s12883-022-03033-1

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: The efficacy of recanalization treatment in patients with ischemic stroke due to large vessel occlusion (LVO) is highly time dependent. We aimed to investigate the effects of an optimization of prehospital and intrahospital pathways on time metrics and efficacy of endovascular treatment in ischemic stroke due to LVO. Methods: Patients treated with mechanical thrombectomy (MT) at the Hospital of St. John of God Vienna, Austria, between 2013 and 2020 were extracted from the Austrian Stroke Unit Registry. Study endpoints including time metrics, early neurological improvement and functional outcome measured by modified Rankin Scale (mRS) at 3 months were compared before and after optimization of prehospital and intrahospital pathways. Results: Two hundred ninety-nine patients were treated with MT during the study period, 94 before and 205 after the workflow optimization. Workflow optimization was significantly associated with time metrics improvement (door to groin puncture time 45 versus 31 min; p < 0.001), rates of neurological improvement (NIHSS >= 8: 30 (35%) vs. 70 (47%), p = 0.04) and radiological outcome (TICI >= 2b: 71 (75%) versus 153 (87%); p = 0.013). Functional outcome (mRS 0-2: 17 (18%) versus 57 (28%); p = 0.067) and mortality (34 (37%) versus 54 (32%); p = 0.450) at 3 months showed a non-significant trend in the later time period group. Conclusion: The implementation of workflow optimization was associated a significant reduction of intrahospital time delays and improvement of neurological and radiological outcomes.

引用

页数：6

共 22 条

[1] In-hospital systems interventions in acute stroke reperfusion therapy: a meta-analysis [J].

Baskar, Prithvi Santana ;

Chowdhury, Seemub Zaman ;

Bhaskar, Sonu Menachem Maimonides .

ACTA NEUROLOGICA SCANDINAVICA, 2021, 144 (04) :418-432

[2] In-hospital acute stroke workflow in acute stroke - Systems-based approaches [J].

Baskar, Prithvi Santana ;

Cordato, Dennis ;

Wardman, Daniel ;

Bhaskar, Sonu .

ACTA NEUROLOGICA SCANDINAVICA, 2021, 143 (02) :111-120

[3]

Berkhemer OA, 2015, NEW ENGL J MED, V372, P394

[4] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[5] Stroke treatment with alteplase given 3.0-4.5 h after onset of acute ischaernic stroke (ECASS III): additional outcomes and subgroup analysis of a randomised controlled trial [J].

Bluhmki, Erich ;

Chamorro, Angel ;

Davalos, Antoni ;

Machnig, Thomas ;

Sauce, Christophe ;

Wahlgren, Nils ;

Wardlaw, Joanna ;

Hacke, Werner .

LANCET NEUROLOGY, 2009, 8 (12) :1095-1102

[6] A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network [J].

Bohmann, Ferdinand O. ;

Tahtali, Damla ;

Kurka, Natalia ;

Wagner, Marlies ;

You, Se-Jong ;

de Rochemont, Richard du Mesnil ;

Berkefeld, Joachim ;

Hartmetz, Ann-Kathrin ;

Kuhlmann, Andrea ;

Lorenz, Matthias W. ;

Schuetz, Ansgar ;

Kress, Bodo ;

Henke, Christian ;

Tritt, Stephanie ;

Meyding-Lamade, Uta ;

Steinmetz, Helmuth ;

Pfeilschifter, Waltraud .

CEREBROVASCULAR DISEASES, 2018, 45 (3-4) :141-148

[7] Acute stroke units in Austria are being set up on a national level following evidence-based recommendations and structural quality criteria [J].

Brainin, M ;

Steiner, M .

CEREBROVASCULAR DISEASES, 2003, 15 :29-32

[8] Bridging Therapy and Occlusion Site Influence Symptomatic Hemorrhage Rate after Thrombectomy: A Daily Practice Study in 623 Stroke Patients [J].

Cabrera-Maqueda, Jose Maria ;

Alba-Isasi, Maria Teresa ;

Diaz-Perez, Jose ;

Albert-Lacal, Laura ;

Morales, Ana ;

Parrilla, Guillermo .

CEREBROVASCULAR DISEASES, 2021, 50 (03) :279-287

[9] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[10] Effect of prehospital workflow optimization on treatment delays and clinical outcomes in acute ischemic stroke: A systematic review and meta-analysis [J].

Chowdhury, Seemub Zaman ;

Baskar, Prithvi Santana ;

Bhaskar, Sonu .

ACADEMIC EMERGENCY MEDICINE, 2021, 28 (07) :781-801

← 1 2 3 →