Daniel Haase, MD, (he/him/his)
Associate Professor of Emergency Medicine and Surgery
R. Adams Cowley Shock Trauma Center
Baltimore, MD
Disclosure information not submitted.
Nathaniel Woods, BSN, CCRN
Registered Nurse
7The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, Maryland, USA, United States
Disclosure information not submitted.
Zoe Gasparotti, BNS
Nurse
University of Maryland Nedical Center, United States
Disclosure information not submitted.
Richa Beher, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
William Gum, BS
Student
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Manal Faisal, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Daniel Najafali, BS
Student
University of Maryland Research Associate Program
Baltimore, Maryland, United States
Disclosure information not submitted.
Gaurav Jindal, MD
Physician
3Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA 4Department of Neuroradiology, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
Disclosure information not submitted.
Chad Schrier, MSN
Registered Nurse
University of Maryland Medical Center, United States
Disclosure information not submitted.
Karen Yarbrough, DNP, CRNP
Stroke Program Director
3Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Louis Lee, BSN
Registered Nurse
University of Maryland Medical Center, United States
Disclosure information not submitted.
Mary Ellen Dietrich, BSN
Registered Nurse
University of Maryland Medical Center, United States
Disclosure information not submitted.
Karen McQuillan, DNP
Director
University of Maryland Medical Center, United States
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Ikram Afridi, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Vera Bzhilyanskaya, BS
Student
University of Maryland Research Associate Program
College Park, Maryland, United States
Disclosure information not submitted.
Leenah Afridi, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Bhakti Panchal, BS
Student
University of Maryland School of Medicine
Baltimore, Maryland, United States
Disclosure information not submitted.
Austin Widjaja
Student
1The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Muhammad Ullah, BS
Student
University of Maryland Research Associate Program, United States
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Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
Disclosure information not submitted.
Title: Assessing the Critical Care Resuscitation Unit’s Stroke Operations During the Coronavirus Pandemic
Introduction:
The Coronavirus Disease 2019 (COVID-19) pandemic brought many challenges to hospitals throughout the world. The strict safety protocols have led to delayed recognition and treatment for patients that need time sensitive interventions. The Critical Care Resuscitation Unit (CCRU) at the University of Maryland Medical Center expedites interhospital transfers (IHT) for critically ill patients that need time-sensitive interventions, such as, patients with an ischemic stroke from a large vessel occlusion (IS-LVO) requiring endovascular mechanical thrombectomy (EVMT). Our study investigated the CCRU operations while caring for this high-risk patient population during the pandemic.
Methods:
We performed a pre-post study of IHT patients who needed EVMT at a comprehensive stroke center. We compared essential time intervals for patient care, outcomes between the pre-pandemic (PP: 01/2018-02/2020) vs. during pandemic period (DP 03/2020-05/2021). We used descriptive analysis and time series analysis to compare both groups.
Results:
We analyzed 154 PP patients (6 patients/month) vs. 71 DP patients (5 patients/month). The length of stay in the Emergency Department (EDLOS) was 157 [Interquartile (IQR) 118-199)] minutes for PP, 171 [130-211, p=0.33] minutes for DP patients. Time intervals from CCRU arrival to thrombectomy suite for PP was 17 [11-28] minutes vs. 9 [6-16, p=0.001] minutes for DP patients. Time from CCRU arrival to recanalization was 88 [71-122] for PP vs. 78 [53-105, p=0.005] for DP patients. Age, National Institute of Health Stroke Score (NIHSS), Thrombolysis In Cerebral Infarction scale (TICI), and 90-day modified Rankin Score (mRS) were similar between groups. Percentage of patients with good 90-day mRS, defined as ≤ 2, for DP was 40%, compared to 33% (p=0.3) for PP patients.
Conclusions:
Our teamwork and flow were efficient during the pandemic. Although ED LOS increased during the pandemic, though not statistically significant, CCRU operations and overall essential time intervals for stroke patient care at University of Maryland Medical Center improved during the COVID-19 pandemic. A higher percentage of DP patients achieved good functional outcomes (90-day mRS), although not statistically significant compared to PP patients. Additional studies are necessary to further investigate our observations