ABSTRACT
Background The use of general anesthesia (GA) during mechanical thrombectomy has been shown to be safe for those patients undergoing mechanical thrombectomy. One criticism of GA, however, is the extra time it takes to perform. Processes that reduce time to reperfusion can improve outcome. We sought to look at the effect of pre-transfer intubation (PTI) on patient flow and outcome. Methods A system wide stroke program was implemented during the COVID pandemic;the program consists of a comprehensive stroke center with 10 network hospitals, 8 referring for thrombectomy. Patients were referred for mechanical thrombectomy based on AHA guidelines and VIZ AI software processing performed at the sending facilities. All patients were transferred directly to the endovascular suite. PTI was implemented for patients with high NIHSS. Data was collected from November 2020 through mid-March 2021 during the peak months of the COVID-19 surge in Georgia. Results 52 patients underwent mechanical thrombectomy. 38 patients were from network hospital emergency departments;19% were COVID positive. 16 patients underwent PTI, and 22 patients were intubated in the endovascular suite. Initial NIHSS was significantly higher in PTI patients (17 versus 11, p < 0.05). The Door-in-Door-Out time was not significantly different;176 ± 68 min with PTI and 140 ± 37 min for those intubated at the CSC (p = 0.065). Door to groin puncture at the CSC was significantly shorter for PTI, 18 ± 6 min, compared to those intubated at the CSC, 32 ± 19 min (p < 0.05). Despite a higher initial NIHSS, there was no significant difference in the NIHSS at discharge nor the percent of patients that were independent at discharge, mRS 0-2. There was a trend toward a larger change in NIHSS in the PTI group. There were no adverse events associated with PTI and all patients had a persistent LVO on the initial angiogram. Conclusion An established protocol of pre-transfer intubation is safe and feasible. Intubation prior to transfer does not negatively affect DIDO yet significantly decreases door to groin time at the CSC.
ABSTRACT
COVID-19 has created many constraint-related challenges for humans in general and organisations in particular. Specifically, businesses that require physical contact, such as mobility providers, have been severely impacted by the crisis. This paper reveals how mobility platforms and their ecosystem of actors have adapted faster than their non-platform competitors to become resilient. Whereas current research on resilience explicitly deals with the concept of organisational resilience, community resilience, or IT resilience, socio-technical characteristics of digital platforms have not been investigated. We build on a case survey approach, including heterogeneous qualitative evidence of 266 actions of 171 analysed mobility platforms. The results show five archetypes of how mobility platforms leverage their platform-based nature and the ecosystem to build resilience. Based on this, we develop the concept of platform ecosystem resilience as leveraging socio-technical factors of digital platforms and ecosystems frugally to design, deploy and use situation-specific responses to prepare for, endure and adapt by capturing new opportunities and engaging in transformative activities to cope with exogenous shocks and become resilient for future disruptions. Our results emphasise the importance of platform ecosystems for practitioners and policy planners to develop the "new normal" rather than resuming existing practices.