Engaging anaesthesia professionals as co-faculty in stroke thrombectomy simulation training: associations with clinical care and patient outcomes.

Abstract

Background: Simulation-based training for endovascular thrombectomy (EVT) may improve care for patients with acute ischaemic stroke. This study investigated whether engaging anaesthesia professionals as co-faculty in an established in situ simulation programme influenced EVT care and patient outcomes.

Methods: This single centre pre-post interventional study (2017-2023) evaluated the impact of revising an EVT simulation training programme by engaging anaesthesia professionals in its design, delivery, and debriefing. Outcomes were measured by changes in: (1) anaesthetic management (relative and absolute time systolic blood pressure was outside protocol thresholds, hypoxic time, and protocol adherence), (2) workflow process (time metrics, successful revascularisation rates, and intraprocedural complications), and (3) patient outcomes (intracerebral haemorrhage, National Institute of Health Stroke Scale scores and modified Rankin Scale scores).

Results: A total of 275 stroke patients were treated with EVT during the study period (189 pre- and 86 postintervention). Anaesthetic management improved significantly in the postintervention group, with a decrease in the proportion of time that systolic blood pressure remained outside thresholds (37.0% to 27.7%, p = 0.02), increased compliance with recommended anaesthetics (27.5% to 100.0%, p < 0.001), and a reduction in hypoxia (5 to 0 min, p < 0.001). Time from suite arrival to groin puncture increased from 15 to 20 min in the postintervention group (p = 0.003). No significant differences were observed between the groups in the remaining workflow time metrics, reperfusion rates, or procedural complications. The proportion of patients with an excellent outcome (modified Rankin Scale 0-1) improved significantly from 23.4% to 42.6% in the postintervention group (p = 0.01).

Conclusions: The engagement of anaesthesia professionals in the EVT simulation training faculty was associated with improved EVT anaesthesia care and improved patient outcomes. The multidisciplinary nature of the EVT team should be reflected in faculty composition for EVT simulation training.