Establishing a Stroke Center During the COVID-19 Pandemic: First-year Experiences

Abstract

Establishing a Stroke Center During the COVID-19 Pandemic: First-year Experiences Abstract Objective: This study examines the data of patients of ischemic stroke who underwent intravenous thrombolytic therapy and/or mechanical thrombectomy after applying to the emergency department of a newly opened hospital in our country during the COVID-19 pandemic. Methods: The files of 85 consecutive patients who were hospitalized in the Stroke Centre of XXXXXX with a diagnosis of acute ischemic stroke between January and December 2020 who underwent intravenous thrombolytic therapy and/or mechanical thrombectomy were retrospectively reviewed. Results: Symptom-to-door times (p<0.001) and symptom-to-recanalization/reperfusion times (p=0.005) were significantly higher in those referred from another hospital compared with those first admitted to our hospital. The modified Rankin scale score in the third month was significantly lower in the non-referred group than in the referred group (p=0.046). We found high age (p=0.032), high National Institutes of Health stroke scale/score at admission (p<0.001) and high symptom-to-recanalization time (p=0.046) were risk factors associated with bad outcomes. Conclusion: This work contributes to the literature and provides reference data for new stroke centers that are candidates for service by sharing our first experiences with a newly established stroke center during the pandemic. Keywords: Experiences; Pandemic; Stroke Center

Keywords

• Experiences; Pandemic; Stroke Center

Pandemi Sırasında İnme Merkezi Kurmak: İlk Yıl Deneyimleri

Abstract

Pandemi Sırasında İnme Merkezi Kurmak: İlk Yıl Deneyimleri Özet Amaç: Pandemi döneminde ülkemizde yeni açılan bir hastanenin Nöroloji Yoğun Bakım Ünitesi’ne, acil servise başvurarak yatırılan intravenöz trombolitik tedavi ve/veya mekanik trombektomi uygulanan iskemik inmeli hastaların verilerinin incelenmesi amaçlandı. Yöntemler: Ocak 2020-Aralık 2020 tarihleri arasında XXXXXX İnme Merkezi’nde akut iskemik inme tanısı ile yatırılan ve intravenöz trombolitik tedavi ve/veya mekanik trombektomi uygulanan ardışık 85 hastanın dosyaları retrospektif olarak incelendi. Bulgular: Hastaların ilk semptomdan kapıya kadar geçen süre (p<0,001) ve semptom-rekanalizasyon/reperfüzyon süresi (p=0,005) başka bir hastaneden sevk edilen grupta, direkt olarak hastanemize başvuran gruba göre anlamlı olarak daha uzundu. 3. aydaki mRS skoru sevk edilmeyen grupta, sevk edilen gruba göre anlamlı derecede düşüktü (p=0.046). İleri yaşın (p=0,032), başvuruda yüksek NIHSS’un (p<0,001) ve semptomdan rekanalizasyona kadar geçen sürenin uzun olmasının (p=0,046) kötü sonuçla ilişkili olduğunu bulduk. Sonuç: Pandemi sürecinde yeni kurulan bir inme merkezi olarak ilk deneyimlerimizi paylaşarak literatüre katkıda bulunmak ve hizmete aday yeni inme merkezleri için referans veri sağlamak istedik. Anahtar Kelimeler: İnme Merkezi; Pandemi; Deneyimler

Keywords

• Stroke Center
• Pandemic
• Experiences

References

1. 1. NINDS rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N. Engl J Med 1995;333:1581-7.
2. 2. Hacke, W., Kaste, M., Bluhmki, E., Brozman, M., Dávalos, A., Guidetti, D., et al. ECASS investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317-29.
3. 3. T.C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Araştırma, Geliştirme ve Sağlık Teknolojisi Değerlendirme Dairesi Başkanlığı Akut İskemik İnme Tanı ve Tedavi Rehberi (Versiyon 1.0), T.C. Sağlık Bakanlığı Yayın Numarası: 1152 ISBN: 978-975-590-745-1
4. 4. Saver JL. Time is brain--quantified. Stroke 2006;37:263-266)
5. 5. Tai, M. L. S., Goh, K. J., Kadir, K. A. A., Zakaria, M. I., Yap, J. F., Tan, K. S. Predictors of functional outcome in patients with stroke thrombolysis in a tertiary hospital in Malaysia. Singapore Medical Journal, 2019;60(5):236-240.
6. 6. Bhardwaj, A., Sharma, G., Raina, S. K., Sharma, A., Angra, M. Advanced age and higher National Institutes of Health Stroke Scale Score as predictors of poor outcome in ischemic stroke patients treated with alteplase: a study from a tertiary care centre in rural North-west India. Journal of neurosciences in rural practice,2017; 8(2), 236-240.
7. 7. Wollenweber FA, Tiedt S, Alegiani A, Alber B, Bangard C, Berrouschot J, et al. Functional outcome following stroke thrombectomy in clinical practice 2019, 50.9: 2500-2506.
8. 8. Finitsis, S., Epstein, J., Richard, S., Bourcier, R., Sibon, I., Dargazanli, C., et al. ETIS Registry Investigators. Age and Outcome after Endovascular Treatment in Anterior Circulation Large-Vessel Occlusion Stroke: ETIS Registry Results. Cerebrovascular Diseases, 2021; 50(1): 68-77

9. 9. Chu, H. J., Tang, S. C., Lee, C. W., Jeng, J. S., Liu, H. M. Endovascular thrombectomy for acute ischemic stroke: a single-center experience in Taiwan. Journal of the Formosan Medical Association, 2018; 117(9): 806-813
10. 10. Venema, E., Groot, A. E., Lingsma, H.et al. Effect of interhospital transfer on endovascular treatment for acute ischemic stroke. Stroke, 2019, 50.4: 923-930.
11. 11. Saver, J. L., Smith, E. E., Fonarow, G. C., Reeves, M. J., Zhao, X., Olson, D. M. et al. The “golden hour” and acute brain ischemia: presenting features and lytic therapy in> 30 000 patients arriving within 60 minutes of stroke onset. Stroke, 2010;41(7) :1431-1439.
12. 12. Mikulik R, Kadlecova P, Czlonkowska A, et al. Factors influencing in-hospital delay in treatment with intravenous thrombolysis. Stroke 2012;43:1578–83
13. 13. Reuter B, Stock C, Ungerer M, Hyrenbach S, Bruder I, Ringleb PA, et al.Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning. Front Neurol. 2020 Sep 30;11:573381. doi: 10.3389/fneur.2020.573381. PMID: 33101182; PMCID: PMC7555607.
14. 14. Richter, D., Weber, R., Eyding, J., Bartig, D., Misselwitz, B., Grau, A. et al. Acute ischemic stroke care in Germany–further progress from 2016 to 2019. Neurological Research and Practice,2021; 3(1), 1-7.
15. 15. Forlivesi, S., Bonetti, B. Cappellari, M. Number of ischemic strokes potentially eligible for revascularization treatments in an Italian Comprehensive Stroke Center: a modeling study. J Thromb Thrombolysis 2018; 46, 427–430.
16. 16. Çetiner M, Canbaz Kabay S, Aydın H. Akut İskemik İnmede İntravenöz Trombolitik Tedavi: Kütahya Deneyimleri. Turk J Neurol 2017;23:193- 198.
17. 17. Kunt R. Bir devlet hastanesi bakış açısıyla akut iskemik inmede intravenöz trombolitik tedavi. Türk Beyin Damar Hast Der 2016;22:91-99.
18. 18. Çetiner, M., Arsava, E. M., Topçuoğlu, M. A. Thrombolytic Therapy for Stroke in Turkey: Meta-analysis of Published Case Series. Turk J Neurol, 2020; 26, 138-141.
19. 19. The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt PA stroke trials. Lancet. 2004; 363: 768–774.