Fast-track intubation for accelerated interventional stroke treatment

Neurocrit Care. 2012 Dec;17(3):354-60. doi: 10.1007/s12028-012-9671-7.


Background: As intravenous thrombolysis frequently fails to recanalize occluded proximal intracerebral arteries, interventional recanalization therapy is increasingly being considered as treatment option in acute ischemic stroke patients. The optimal periprocedural patient management for these interventions is currently unknown. The aim of this study was to identify factors delaying door-to-treatment times, and to evaluate the effect of a fast-track intubation standard operating procedure (I-SOP) on door-to-angiography time.

Methods: First, we retrospectively reviewed records of 48 acute stroke patients who were treated by interventional recanalization of intracranial occlusions between 2006 and 2009 at our institution. Time to angiography was defined as time from hospital admission to the beginning of the angiographic procedure. Second, an I-SOP for fast-track intubation was implemented and effects on door-to-angiography time were prospectively analyzed in 23 consecutive patients.

Results: In the retrospective dataset (n = 48), the mean door-to-angiography time was 2.2 ± 0.1 h (mean ± SEM). A clinically relevant time loss attributable to the intubation procedure was suggested by a 51 ± 21 min shorter door-to-angiography time for patients already intubated prior to admission (P = 0.0189). Additional factors associated with a prolonged door-to-angiography time were: door-to-diagnosis time (P < 0.001), onset-to-door time (P = 0.0117), and male gender (mean difference +27 ± 15 min, P = 0.0822). In the prospective dataset (n = 23), I-SOP implementation reduced mean door-to-angiography time by 25 ± 10 min (P = 0.0164).

Conclusions: In acute stroke patients, intubation prior to interventional recanalization therapy can delay treatment initiation. The implementation of an I-SOP accelerates interventional treatment initiation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / drug therapy
  • Brain Ischemia / mortality
  • Cerebral Angiography / statistics & numerical data
  • Cerebral Revascularization / mortality
  • Databases, Factual / statistics & numerical data
  • Emergency Medical Services / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Intubation, Intratracheal / mortality*
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care / statistics & numerical data
  • Patient Transfer / statistics & numerical data*
  • Retrospective Studies
  • Stroke / diagnostic imaging
  • Stroke / drug therapy*
  • Stroke / mortality*
  • Thrombolytic Therapy / mortality*
  • Time-to-Treatment / statistics & numerical data*