Abstract
Background
As intravenous thrombolysis frequently fails to recanalize occluded proximal intracerebral arteries, interventional recanalization therapy is increasingly being considered as treatment option in acute ischemic stroke patients. The optimal periprocedural patient management for these interventions is currently unknown. The aim of this study was to identify factors delaying door-to-treatment times, and to evaluate the effect of a fast-track intubation standard operating procedure (I-SOP) on door-to-angiography time.
Methods
First, we retrospectively reviewed records of 48 acute stroke patients who were treated by interventional recanalization of intracranial occlusions between 2006 and 2009 at our institution. Time to angiography was defined as time from hospital admission to the beginning of the angiographic procedure. Second, an I-SOP for fast-track intubation was implemented and effects on door-to-angiography time were prospectively analyzed in 23 consecutive patients.
Results
In the retrospective dataset (n = 48), the mean door-to-angiography time was 2.2 ± 0.1 h (mean ± SEM). A clinically relevant time loss attributable to the intubation procedure was suggested by a 51 ± 21 min shorter door-to-angiography time for patients already intubated prior to admission (P = 0.0189). Additional factors associated with a prolonged door-to-angiography time were: door-to-diagnosis time (P < 0.001), onset-to-door time (P = 0.0117), and male gender (mean difference +27 ± 15 min, P = 0.0822). In the prospective dataset (n = 23), I-SOP implementation reduced mean door-to-angiography time by 25 ± 10 min (P = 0.0164).
Conclusions
In acute stroke patients, intubation prior to interventional recanalization therapy can delay treatment initiation. The implementation of an I-SOP accelerates interventional treatment initiation.
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Acknowledgments
This study was supported by a grant from the Else Kroener Fresenius Stiftung to RV. We thank the physicians and the nursing staff of our department for cooperation.
Conflict of interest
Oliver Herrmann, Andreas Hug, Julian Bösel, Juliana Johanna Petersen, Marius Hartmann, Stefan Rohde, Martin Bendszus, Peter Arthur Ringleb, Werner Hacke, and Roland Veltkamp have no conflicts of interest concerning this study.
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Andreas Hug and Oliver Herrmann contributed equally to this work.
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Herrmann, O., Hug, A., Bösel, J. et al. Fast-Track Intubation for Accelerated Interventional Stroke Treatment. Neurocrit Care 17, 354–360 (2012). https://doi.org/10.1007/s12028-012-9671-7
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DOI: https://doi.org/10.1007/s12028-012-9671-7