Process improvement with pre-tranfser intubation for patients undergoingmechanical thrombectomy;not just for the covid pandemic

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.