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

Pouya Tahsili-Fahadan; Jing Wang; Seajin Yi; Yun Fang; Crystal Tulloch; Jackie Leutbecker; Edward Greenberg; Dan Dinescu; Laith R Altaweel

doi:10.1007/s12028-024-02199-5

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

Neurocrit Care. 2025 Jan 16. doi: 10.1007/s12028-024-02199-5. Online ahead of print.

Authors

Pouya Tahsili-Fahadan^{1

2

3}, Jing Wang¹, Seajin Yi¹, Yun Fang¹, Crystal Tulloch⁴, Jackie Leutbecker¹, Edward Greenberg⁵, Dan Dinescu^{1

2}, Laith R Altaweel^{6

7}

Affiliations

¹ Divisions of Vascular Neurology and Neurocritical Care, Inova Fairfax Medical Campus, Inova Neuroscience and Spine Institute, 3300 Gallows Rd., Falls Church, VA, 22042 , USA.
² Department of Medical Education, University of Virginia, Inova Campus, Falls Church, VA, USA.
³ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Cardiovascular Invasive Specialty, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁵ Fairfax Radiological Consultants Professional Limited Liability Company, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁶ Divisions of Vascular Neurology and Neurocritical Care, Inova Fairfax Medical Campus, Inova Neuroscience and Spine Institute, 3300 Gallows Rd., Falls Church, VA, 22042 , USA. [email protected].
⁷ Department of Medical Education, University of Virginia, Inova Campus, Falls Church, VA, USA. [email protected].

PMID: 39821566
DOI: 10.1007/s12028-024-02199-5

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.

Keywords: Acute ischemic stroke; Analgosedation; Hemodynamics; Mechanical thrombectomy; Neurocritical care.