Academic Journal
Role of the Critical Care Resuscitation Unit in a Comprehensive Stroke Center: Operations for Mechanical Thrombectomy During the Pandemic.
| Τίτλος: | Role of the Critical Care Resuscitation Unit in a Comprehensive Stroke Center: Operations for Mechanical Thrombectomy During the Pandemic. |
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| Συγγραφείς: | Tran QK; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.; University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Program in Trauma, Baltimore, Maryland.; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland., Okolo R; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland., Gum W; University of Maryland Medical Center, Critical Care Resuscitation Unit, Baltimore, Maryland., Faisal M; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland., Gambhir V; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland., Singh A; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland., Gasparotti Z; University of Maryland Medical Center, Critical Care Resuscitation Unit, Baltimore, Maryland., Schrier C; University of Maryland Medical Center, Department of Neurology, Baltimore, Maryland., Jindal G; University of Maryland Medical Center, Department of Neurology, Baltimore, Maryland.; University of Maryland School of Medicine, Department of Neuroradiology, Baltimore, Maryland., Teeter W; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.; University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Program in Trauma, Baltimore, Maryland., Downing J; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland.; University of Maryland Medical Center, Critical Care Resuscitation Unit, Baltimore, Maryland., Haase DJ; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.; University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Program in Trauma, Baltimore, Maryland. |
| Πηγή: | The western journal of emergency medicine [West J Emerg Med] 2024 Jul; Vol. 25 (4), pp. 548-556. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Department of Emergency Medicine, University of California, Irvine Country of Publication: United States NLM ID: 101476450 Publication Model: Print Cited Medium: Internet ISSN: 1936-9018 (Electronic) Linking ISSN: 1936900X NLM ISO Abbreviation: West J Emerg Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2011>- : Irvine, CA : Department of Emergency Medicine, University of California, Irvine Original Publication: Orange, CA : California Chapter of the American Academy of Emergency Medicine |
| Ιατρικοί όροι (MeSH): | COVID-19*/epidemiology , Thrombectomy*/methods , Ischemic Stroke*/therapy , Ischemic Stroke*/surgery , Time-to-Treatment*, Emergency Service, Hospital/organization & administration ; Resuscitation/methods ; Stroke/therapy ; Humans ; Male ; Female ; Retrospective Studies ; Aged ; Middle Aged ; Critical Care ; SARS-CoV-2 ; Pandemics ; Registries ; Patient Transfer ; Aged, 80 and over |
| Περίληψη: | Introduction: Standard of care for patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) includes prompt evaluation for urgent mechanical thrombectomy (MT) at a comprehensive stroke center (CSC). During the start of the coronavirus 2019 pandemic (COVID-19), there were reports about disruption to emergency department (ED) operations and delays in management of patients with AIS-LVO. In this study we investigate the outcome and operations for patients who were transferred from different EDs to an academic CSC's critical care resuscitation unit (CCRU), which specializes in expeditious transfer of time-sensitive disease. Methods: This was a pre-post retrospective study using prospectively collected clinical data from our CSC's stroke registry. Adult patients who were transferred from any ED to the CCRU and underwent MT were eligible. We compared time intervals in the pre-pandemic (PP) period between January 2018- February 2020, such as ED in-out and CCRU arrival-angiography, to those during the pandemic (DP) between March 2020-May 31, 2021. We used classification and regression tree (CART) analysis to identify which time intervals, besides clinical factors, were associated with good neurological outcome (90-day modified Rankin scale 0-2). Results: We analyzed 203 patients: 135 (66.5%) in the PP group and 68 (33.5%) in the DP group. Time from ED triage to computed tomography (difference 7 minutes, 95% confidence interval [CI] -12 to -1, P < 0.01) for the DP group was statistically longer, but ED in-out was similar for both groups. Time from CCRU arrival to angiography (difference 9 minutes, 95% CI 4-13, P < 0.01) for the DP group was shorter. Forty-nine percent of the DP group achieved mRS ≤ 2 vs 32% for the PP group (difference -17%, 95% CI -0.32 to -0.03, P < 0.01). The CART identified initial National Institutes of Health Stroke Scale, age, ED in-and-out time, and CCRU arrival-to-angiography time as important predictors of good outcome. Conclusion: Overall, the care process in EDs and at this single CSC for patients requiring MT were not heavily affected by the pandemic, as certain time metrics during the pandemic were statistically shorter than pre-pandemic intervals. Time intervals such as ED in-and-out and CCRU arrival-to-angiography were important factors in achieving good neurologic outcomes. Further study is necessary to confirm our observation and improve operational efficiency in the future. |
| Competing Interests: | Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare. |
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| Entry Date(s): | Date Created: 20240719 Date Completed: 20240719 Latest Revision: 20240721 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11254161 |
| DOI: | 10.5811/westjem.18335 |
| PMID: | 39028240 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1936-9018 |
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| DOI: | 10.5811/westjem.18335 |