Impact of multidisciplinary simulation training on endovascular thrombectomy: Workflow, patient outcomes and anaesthetic management.

Abstract

BackgroundEndovascular thrombectomy (EVT) is a time-sensitive treatment for acute stroke patients. This study was conducted to evaluate the impact of multidisciplinary simulation training on workflow, patient outcomes, and anaesthetic management during EVT.MethodsThis pre-post interventional study treated 244 stroke patients with EVT (55 pre- and 189 postintervention) between May 2016 and November 2021. A multidisciplinary in situ EVT simulation training programme, including a new EVT protocol with a higher blood pressure target range, was implemented in 2017. We assessed the following variables: (1) Workflow metrics: Process times, revascularisation success, and complications; (2) patient outcomes: Symptomatic intracerebral haemorrhage, functional outcomes at 90 days, and the National Institute of Health Stroke Scale postprocedure; and (3) anaesthetic management: Systolic blood pressure (SBP) thresholds, adherence to protocol, and the conversion rate from conscious sedation to general anaesthesia.ResultsThe postintervention workflow improved significantly, with a reduction in the median groin puncture-to-reperfusion time from 76 to 53 min (p = 0.003) and in the door-to-angio suite arrival time from 54 to 35 min (p < 0.001). Other EVT workflow metrics and patient outcomes remained unchanged. Postintervention haemodynamic management significantly changed with increasing median SBP outside protocol thresholds (14 vs. 28.5 min, p = 0.003). A variety of different combinations of anaesthetics were used for conscious sedation.ConclusionsMultidisciplinary simulation training improved EVT workflow times, highlighting its potential to optimise processes. However, the lack of significant improvement in patient outcomes and anaesthetic management suggests the need for a stronger focus on anaesthesia in future training to optimise EVT outcomes.