Neurocritical Care Rapid Response Team Providing Critical Care Support During Mechanical Thrombectomy of Emergent Large Vessel Occlusion Stroke.

Abstract

Background:  Acute ischemic stroke with medium and large vessel occlusion is a leading cause of morbidity and mortality, in which timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. Effective analgosedation and hemodynamic management during MT are critical to patient outcomes and typically managed by anesthesia. Because of inconsistent anesthesia support at our institution, we implemented a dedicated neurocritical care rapid response team (NCC-RRT) to manage these aspects of care. The primary outcome of our study was door-to-groin puncture time, before and after the implementation of the NCC-RRT. Secondary outcomes included door-to-recanalization time, patient disposition status, and the need for emergent anesthesia support.

Methods:  We conducted a prospective analysis of patients with acute ischemic stroke undergoing MT at a comprehensive stroke center between January 2021 and December 2023. The study compared two periods: era 1 (pre-NCC-RRT, January to October 2021) and era 2 (post-NCC-RRT, December 2021 to December 2023). We excluded inpatient stroke alerts and patients intubated at outside hospitals. The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support.

Results:  A total of 373 patients were included in the study, with 86 patients in era 1 and 287 in era 2. The implementation of the NCC-RRT was associated with a statistically significant reduction in median DGP and door-to-recanalization times by 11.7% and 12.6%, respectively. NCC-RRT was also associated with a 21.4% increase in general anesthesia utilization, and no patients required emergent anesthesia support.

Conclusions:  The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.