FAST APPLICATION OF PROCEDURAL MEASURES TO REDUCE INPATIENT DELAYS FOR INTRAVENOUS THROMBOLYSIS AND MECHANICAL THROMBECTOMY

Abstract

Introduction: The efficacy of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in
ischemic stroke is decreasing over time from symptoms onset. Therefore, a number of studies describe
measures that reduce time from patient arrival to IVT («Door-to-needle» – DtN). We tested the applicability
of such well-described procedural changes in a German university hospital. We also describe our effort to
implement changes to a mechanical thrombectomy protocol in order to reduce «Door-to-Groin Puncture»
(DtG) time.
Methods: The existing stroke treatment protocol at the St.Josef University Hospital in Bochum was
evaluated and restructured within four months in order to reduce (DtN) and (DtG) time. Among other
measures, we implemented the following basic changes:
– Prenotification of the Emergency Department through the pre-hospital physician or the paramedic, respectively.
– Emergency Department Team informs directly the staff of the CT scanner and the anesthetist about the
arrival of the patient.
– Measurement of the INR value through a portable device in the ED («Point of Care measurement»).
– Application of IVT (bolus rtPA) in the CT scan room.
We then compared the registry of patients treated with IVT and/or MT the first 11 months after the
implementation of these measures to patient data from the previous two years.
Results: 76 patients were treated with IVT and / or MT the first 11 months after the application of the
new protocol and 129 the 2 years before the implementation of the changes. The mean DtN time was
reduced from 53 ± 20 to 36 ± 16 minutes. The percentage of patients with DtN ≤ 30 min increased from
7.9% to 44.8%. In addition, the mean DtG for MT was reduced from 86 ± 36 to 72 ± 25 minutes. The
percentage of patients with DtG ≤ 60 min increased from 18.1% to 34.5%.
Conclusions: We highlighted the potential of applying an optimized IVT model within four months. In
addition, we proved the effect of these measures in reducing DtG time for MT. With the collaboration of
out-of-hospital doctors, the Emergency Department and the Stroke Unit we achieved faster application
of IVT and MT. Therefore we conclude that procedural changes for the optimization of acute stroke treatment protocols, described by foreign clinics, can be successfully transferred to other countries.