Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience

Rangel, India; Palmisciano, Paolo; Vanderhye, Vanesa K.; Ahmadieh, Tarek Y. El; Wahood, Waseem; Demaerschalk, Bart M.; Sands, Kara; O’Carroll, Cumara B; Krishna, Chandan; Zimmerman, Richard S.; Chong, Brian W.; Bendok, Bernard R.; Turkmani, Ali

doi:10.1016/j.mayocpiqo.2022.05.009

Cited by 13 publications

(26 citation statements)

References 35 publications

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“…In the present study, despite transfer times being longer in VI+ patients, vascular imaging acquisition at LCSs was associated with a mean reduction of 13 min from thrombectomy-capable center arrival to groin puncture and with a higher proportion of patients with a DTP below 60 min, considered a benchmark time among those transferred 7. These results are in agreement with prior studies testing protocols including vascular imaging at LSCs 16 22…”

Section: Discussionsupporting

confidence: 92%

Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis

Flores

García‐Tornel

Seró

et al. 2023

J NeuroIntervent Surg

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BackgroundThe influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI− at LSC arrival on variables related to workflows using data from the RACECAT Trial.ObjectiveTo compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition.MethodsWe included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients.ResultsAmong 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69–96) vs VI− 76 (IQR 59–98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26–53) vs VI− 54 (IQR 40–70), P<0.001).ConclusionAmong patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.

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Section: Discussionsupporting

confidence: 92%

Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis

Flores

García‐Tornel

Seró

et al. 2023

J NeuroIntervent Surg

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“…The American stroke association recommended median DTP of 90 min or less, and less than 60 min for transferred patients. Great effort is made in order to reduce DTP using various intervention strategies, including rapid triage protocol, early stroke team notification, using direct transfer to the computed tomography (CT) room and from there to the angiography-suite ('no turn back approach'), direct transfer to the angiography-suite, stroke simulation training and more [21].…”

Section: Door To Groin Puncture Timementioning

confidence: 99%

Current advances in endovascular treatment

Molad

Honig

2023

Current Opinion in Neurology

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Purpose of reviewEndovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients selection and periprocedural management. Recent findingsRecent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.

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Section: Process Mappingmentioning

confidence: 99%

“…Process mapping was used to describe either the current practice at a given site or the ideal workflow, identify potential pitfalls that inhibited care quality, or identify targets for QI activities. 4,12,13,20,25 For processes of care that involve many disciplines, process mapping ideally included staff members from all involved services. 5,13 For example, Hennebry et al 13 included paramedics, telephone operators, clerical staff, laboratory staff, porters, radiographers, nurses, and physicians in process mapping to improve door-to-needle times.…”

Section: Process Mappingmentioning

confidence: 99%