Abstract TP303: Improved Metrics and Outcomes Post Implementation of an ELVO Taskforce

Abstract

Objective: To assess whether the implementation of a standardized protocol for the rapid diagnosis, transfer, and management of emergent large vessel occlusions (ELVO) improves treatment times and reduces disability in patients that undergo mechanical thrombectomy. Methods: Retrospective review was conducted on all patients who underwent thrombectomy within 6 hours of last known well (LKW) from May 22, 2016 to May 1, 2019. Patients with proximal anterior circulation occlusion confirmed on CTA and admission NIHSS of ≥6 were included. Comparisons were made to assess differences in workflow metrics and outcomes pre- and post-ELVO taskforce implementation. 90-day modified Rankin Scale scores (mRS) and patient information was collected from the Houston Methodist Hospital Outcomes Based Prospective Endpoints in Stroke (HOPES) registry. Results: A total of 287 patients met inclusion criteria. 116 were excluded for low NIHSS, out-of-window presentation, undocumented metrics, or lost to follow up. 102 patients presented prior to protocol implementation, with 48 (71.81y [SD±13.51]; 50% M) arriving directly to our CSC and 54 (68.56y [SD±16.85]; 46% M) arriving via inter-facility transfer from a PSC. 69 patients presented post-implementation, 32 (69.78y [SD±16.33]; 53% M) directly and 37 (70.57y [SD±13.96]; 62% M) were transferred. In those presenting directly to the CSC, a statistically significant reduction in the mean door to CT time was observed post-implementation, 12.25 to 5.03 minutes (7.22, 95% CI [1.50, 12.93] p=0.007). In those who were transferred, we found a significant reduction in the mean door-in to door-out time, 138.06 to 128.00 minutes (10.06, 95% CI [7.90, 28.02] p=0.028). A trend towards improved functional outcomes was observed in both cohorts post-protocol implementation. Admission NIHSS, use of lytics, and LKW were found not to be confounders. Conclusion: Based on our review of patients who underwent mechanical thrombectomy, implementation of a standardized protocol for the management of ELVO patients both improved treatment times and showed a trend toward greater functional independence at 90 days. This protocol can be easily replicated to help improve stroke care and potentially reduce disability for patients presenting with ELVO.