Abstract WP279: Can We Reduce Door-to-Needle Times and Improve Outcome by Giving tPA on the CT Suite?

Abstract

Objectives: The time to administration of intravenous (iv) tPA has a relevant impact on patients outcome. Our treatment protocol has been modified in order to improve our latency times by starting iv tPA bolus in the computed tomography room (CT-tPA). We aimed to evaluate the impact of CT-tPA on door-to-needle times and functional outcome in patients with acute ischemic stroke. Material and methods: We consecutively evaluated 70 patients treated in accordance with the CT-tPA protocol from June 2011 to June 2012. Those patients were compared to 130 patients from the previous year who received iv tPA bolus in the Stroke Unit (conventional protocol). Demographic data, baseline stroke severity, and inpatient latency times were evaluated. The primary outcome was the modified Rankin scale (mRS) at 3 months. Functional independency was considered when mRS≤2. Results: Two-hundred patients were evaluated, with mean age of 74.4±11.5 years and median NIHSS of 13 (IQR 11). There was no difference in baseline clinical characteristics at admission between CT-tPA and conventional protocol. The door-to-CT times were similar in both groups. Mean door-to-needle time was 57.1 min in the conventional protocol, and was reduced to 53.4 after CT-tPA protocol implantation. We analyzed the number of patients who received iv tPA bolus bellow 30 and 50 minutes in each group. The CT-tPA group had 9% more patients treated in <30 min (16% vs. 25%) and 11% more treated in <50 min-window (50% vs. 61%) after arrival to the emergency department. Clinically, there was a trend toward a better functional outcome in the CT-tPA protocol, with an increase of 10.7% of patients with mRS≤ 2 at 3 months compared with the conventional protocol (56.9% vs 46.2%). We also observed a reduction of 3-months mortality in patients treated according to the CT-tPA protocol (19% vs. 23%). The application of CT-tPA was not associated with the increase of ICH nor with tPA protocol violations. Conclusions: The CT-tPA protocol reduces door-to-needle times, increasing the number of patients treated bellow the <50 and <30 minutes time-window. We hypothesized that this time-reduction would improve functional outcome in a larger number of patients.