Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil
BackgroundThe global COVID-19 pandemic has had a devastating effect on global health, resulting in a strain on healthcare services worldwide. The faster a patient with acute ischemic stroke (AIS) receives reperfusion treatment, the greater the odds of a good functional outcome. To maintain the time-...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1155931/full |
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| author | Marcelo Klu Ana Claudia de Souza Ana Claudia de Souza Leonardo Augusto Carbonera Leonardo Augusto Carbonera Thais Leite Secchi Thais Leite Secchi Arthur Pille Arthur Pille Marcio Rodrigues Rosane Brondani Andrea Garcia de Almeida Andrea Garcia de Almeida Angélica Dal Pizzol Angélica Dal Pizzol Daniel Monte Freire Camelo Daniel Monte Freire Camelo Gabriel Paulo Mantovani Carolina Oldoni Marcelo Somma Tessari Luiz Antonio Nasi Sheila Cristina Ouriques Martins Sheila Cristina Ouriques Martins |
| author_facet | Marcelo Klu Ana Claudia de Souza Ana Claudia de Souza Leonardo Augusto Carbonera Leonardo Augusto Carbonera Thais Leite Secchi Thais Leite Secchi Arthur Pille Arthur Pille Marcio Rodrigues Rosane Brondani Andrea Garcia de Almeida Andrea Garcia de Almeida Angélica Dal Pizzol Angélica Dal Pizzol Daniel Monte Freire Camelo Daniel Monte Freire Camelo Gabriel Paulo Mantovani Carolina Oldoni Marcelo Somma Tessari Luiz Antonio Nasi Sheila Cristina Ouriques Martins Sheila Cristina Ouriques Martins |
| author_sort | Marcelo Klu |
| collection | DOAJ |
| description | BackgroundThe global COVID-19 pandemic has had a devastating effect on global health, resulting in a strain on healthcare services worldwide. The faster a patient with acute ischemic stroke (AIS) receives reperfusion treatment, the greater the odds of a good functional outcome. To maintain the time-dependent processes in acute stroke care, strategies to reorganize infrastructure and optimize human and medical resources were needed.MethodsData from AIS patients who received thrombolytic therapy were prospectively assessed in the emergency department (ED) of Hospital de Clínicas de Porto Alegre from 2019 to 2021. Treatment times for each stage were measured, and the reasons for a delay in receiving thrombolytic therapy were evaluated.ResultsA total of 256 patients received thrombolytic therapy during this period. Patients who arrived by the emergency medical service (EMS) had a lower median door-to-needle time (DNT). In the multivariable analysis, the independent predictors of DNT >60 min were previous atrial fibrillation (OR 7) and receiving thrombolysis in the ED (OR 9). The majority of patients had more than one reason for treatment delay. The main reasons were as follows: delay in starting the CT scan, delay in the decision-making process after the CT scan, and delay in reducing blood pressure. Several actions were implemented during the study period. The most important factor that contributed to a decrease in DNT was starting the bolus and continuous infusion of tPA on the CT scan table (decreased the median DNT from 74 to 52, DNT ≤ 60 min in 67% of patients treated at radiology service vs. 24% of patients treated in the ED). The DNT decreased from 78 min to 66 min in 2020 and 57 min in 2021 (p = 0.01).ConclusionAcute stroke care continued to be a priority despite the COVID-19 pandemic. The implementation of a thrombolytic bolus and the start of continuous infusion on the CT scan table was the main factor that contributed to the reduction of DNT. Continuous monitoring of service times is essential for improving the quality of the stroke center and achieving better functional outcomes for patients. |
| first_indexed | 2024-03-13T00:29:43Z |
| format | Article |
| id | doaj.art-1aeec2e272f8426797ed7d67fa1d63af |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-13T00:29:43Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-1aeec2e272f8426797ed7d67fa1d63af2023-07-10T15:29:03ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-07-011410.3389/fneur.2023.11559311155931Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in BrazilMarcelo Klu0Ana Claudia de Souza1Ana Claudia de Souza2Leonardo Augusto Carbonera3Leonardo Augusto Carbonera4Thais Leite Secchi5Thais Leite Secchi6Arthur Pille7Arthur Pille8Marcio Rodrigues9Rosane Brondani10Andrea Garcia de Almeida11Andrea Garcia de Almeida12Angélica Dal Pizzol13Angélica Dal Pizzol14Daniel Monte Freire Camelo15Daniel Monte Freire Camelo16Gabriel Paulo Mantovani17Carolina Oldoni18Marcelo Somma Tessari19Luiz Antonio Nasi20Sheila Cristina Ouriques Martins21Sheila Cristina Ouriques Martins22Emergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilEmergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilEmergency Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilNeurology Department, Hospital Moinhos de Vento, Porto Alegre, BrazilBackgroundThe global COVID-19 pandemic has had a devastating effect on global health, resulting in a strain on healthcare services worldwide. The faster a patient with acute ischemic stroke (AIS) receives reperfusion treatment, the greater the odds of a good functional outcome. To maintain the time-dependent processes in acute stroke care, strategies to reorganize infrastructure and optimize human and medical resources were needed.MethodsData from AIS patients who received thrombolytic therapy were prospectively assessed in the emergency department (ED) of Hospital de Clínicas de Porto Alegre from 2019 to 2021. Treatment times for each stage were measured, and the reasons for a delay in receiving thrombolytic therapy were evaluated.ResultsA total of 256 patients received thrombolytic therapy during this period. Patients who arrived by the emergency medical service (EMS) had a lower median door-to-needle time (DNT). In the multivariable analysis, the independent predictors of DNT >60 min were previous atrial fibrillation (OR 7) and receiving thrombolysis in the ED (OR 9). The majority of patients had more than one reason for treatment delay. The main reasons were as follows: delay in starting the CT scan, delay in the decision-making process after the CT scan, and delay in reducing blood pressure. Several actions were implemented during the study period. The most important factor that contributed to a decrease in DNT was starting the bolus and continuous infusion of tPA on the CT scan table (decreased the median DNT from 74 to 52, DNT ≤ 60 min in 67% of patients treated at radiology service vs. 24% of patients treated in the ED). The DNT decreased from 78 min to 66 min in 2020 and 57 min in 2021 (p = 0.01).ConclusionAcute stroke care continued to be a priority despite the COVID-19 pandemic. The implementation of a thrombolytic bolus and the start of continuous infusion on the CT scan table was the main factor that contributed to the reduction of DNT. Continuous monitoring of service times is essential for improving the quality of the stroke center and achieving better functional outcomes for patients.https://www.frontiersin.org/articles/10.3389/fneur.2023.1155931/fullstrokethrombolysisCOVID-19quality of caredoor to needle time |
| spellingShingle | Marcelo Klu Ana Claudia de Souza Ana Claudia de Souza Leonardo Augusto Carbonera Leonardo Augusto Carbonera Thais Leite Secchi Thais Leite Secchi Arthur Pille Arthur Pille Marcio Rodrigues Rosane Brondani Andrea Garcia de Almeida Andrea Garcia de Almeida Angélica Dal Pizzol Angélica Dal Pizzol Daniel Monte Freire Camelo Daniel Monte Freire Camelo Gabriel Paulo Mantovani Carolina Oldoni Marcelo Somma Tessari Luiz Antonio Nasi Sheila Cristina Ouriques Martins Sheila Cristina Ouriques Martins Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil Frontiers in Neurology stroke thrombolysis COVID-19 quality of care door to needle time |
| title | Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil |
| title_full | Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil |
| title_fullStr | Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil |
| title_full_unstemmed | Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil |
| title_short | Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil |
| title_sort | improving door to reperfusion time in acute ischemic stroke during the covid 19 pandemic experience from a public comprehensive stroke center in brazil |
| topic | stroke thrombolysis COVID-19 quality of care door to needle time |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1155931/full |
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