title: Fast-track intubation for accelerated interventional stroke treatment.
abstract: 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.
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. oliver.herrmann@med.uni-heidelberg.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Herrmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Hug
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
authors.forename: Juliana Johanna
authors.initials: JJ
authors.lastname: Petersen
authors.forename: Marius
authors.initials: M
authors.lastname: Hartmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Rohde
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.forename: Peter Arthur
authors.initials: PA
authors.lastname: Ringleb
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Roland
authors.initials: R
authors.lastname: Veltkamp
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D002548:Cerebral Revascularization / Q000401:mortality; D016208:Databases, Factual / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality*; D015912:Thrombolytic Therapy / Q000401:mortality*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*