The impact of implementing a "fast-track" algorithm on time to treatment and outcome in patients with acute ischemic stroke due to large vessel occlusion
Conference Paper/Poster - May 22, 2019
Velicky Matus, Brugger Florian, Kägi Georg, Weber Johannes, Vehoff Jochen
Clinical outcome of endovascular treatment in patients with acute ischemic stroke due to large vessel occlusion (LVO) is largely dependent from the latency between stroke onset and reperfusion. Time-saving protocols for diagnostic work-up and treatment are therefore warranted. We aimed at assessing the impact of establishing a fast-track protocol for drip- and-ship-patients on door-to-groin-puncture times.
Retrospective, single-centre analysis of data from the Swiss Stroke Registry (SSR) of drip and ship stroke patients one year before and one and two years after establishing the protocol in July 2016. Primary outcome: door-to-groin-puncture time; secondary outcomes: NIH SS at 24h, modified Rankin Scale (mRS) at 90 days and reperfusion status (TICI).
99 patients were considered for this analysis. Baseline characteristics (age, NIH SS, preceding i.v. thrombolysis were comparable across patient groups (table 1). Door-to-groin-puncture-time was lower within the first year after implementation of the protocol and further decreased in the second year, then reaching statistical significance (ANOVA: F(2,97)=4.234, p=0.017). In both years mean door-to-groin puncture times were< 45 minutes, which is considered the therapeutic goal for drip-and-ship-patients. Reperfusion status was comparable in all three groups. There were no differences in NIH SS after 24h and in the mRS after 90 days (table 2).
The fast-track protocol reduced the door-to-groin-puncture-time. The reduction was approximately 10 minutes in the first and another 10 minutes in the second year.