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. 2023 Jul 10:14:1155931.
doi: 10.3389/fneur.2023.1155931. eCollection 2023.

Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil

Marcelo Klu  1 , Ana Claudia de Souza  2   3 , Leonardo Augusto Carbonera  2   3 , Thais Leite Secchi  2   3 , Arthur Pille  2   3 , Marcio Rodrigues  1 , Rosane Brondani  2 , Andrea Garcia de Almeida  2   3 , Angélica Dal Pizzol  2   3 , Daniel Monte Freire Camelo  2   3 , Gabriel Paulo Mantovani  2 , Carolina Oldoni  2 , Marcelo Somma Tessari  2 , Luiz Antonio Nasi  1 , Sheila Cristina Ouriques Martins  2   3
Affiliations

Improving door-to-reperfusion time in acute ischemic stroke during the COVID-19 pandemic: experience from a public comprehensive stroke center in Brazil

Marcelo Klu et al. Front Neurol. .

Abstract

Background: The 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.

Methods: Data 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.

Results: A 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).

Conclusion: Acute 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.

Keywords: COVID-19; door to needle time; quality of care; stroke; thrombolysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Median times (IQR 25–75) according to the local of thrombolysis.
Figure 2
Figure 2
Median time for different quality indicators in acute ischemic stroke care during 2019–2020.
Figure 3
Figure 3
Number of suspected acute stroke patients assisted in the emergency room and door-to-needle-time in each year from 2019 (pre-COVID-19 pandemic) and 2020–2021 (during the COVID-19 pandemic).
See this image and copyright information in PMC

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