SEASON 2

Did you ask about thrombolysis? We are here to deliver anxiolysis! In this first of a two-part episode of 2021, we discuss "crisis resource management" (CRM) in acute stroke - a cognitive, mindfulness, and non-technical framework for optimizing clinical performance and working in high-performing teams. CRM is a tool to master four operational domains: that of the self, teamwork, our working environment, and of course, (care for) our patient. Using CRM principles helps make us better clinicians, work more effectively in teams, and maintain a calm sense of vigilance. We re-introduce the concept of a "zero point survey" (Reid et al. 2018) as a starting point before coming on-call for a code stroke and as a tool for better self-awareness and performance. High-performing teams support good clinical outcomes at the resuscitation phase and apply to all subsequent patient care settings. Central to a high-performing team are principles of CRM and their timely application to stroke care. We review our paper in Neurocritical Care titled: "Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care" with three of the authors: Rajendram, Notario, Khosravani

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care by: Phavalan Rajendram, Lowyl Notario, Cliff Reid, Charles R. Wira, Jose I. Suarez, Scott D. Weingart & Houman Khosravani (Neurocritical Care, published in 2020) Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance

Did you ask about thrombolysis? We are here to deliver anxiolysis! In this second of a two-part episode of 2021, we discuss "crisis resource management" (CRM) in acute stroke - a cognitive, mindfulness, and non-technical framework for optimizing clinical performance and working in high-performing teams. CRM is a tool to master four operational domains: that of the self, teamwork, our working environment, and of course, (care for) our patient. Using CRM principles helps make us better clinicians, work more effectively in teams, and maintain a calm sense of vigilance. We re-introduce the concept of a "zero point survey" (Reid et al. 2018) as a starting point before coming on-call for a code stroke and as a tool for better self-awareness and performance. High-performing teams support good clinical outcomes at the resuscitation phase and apply to all subsequent patient care settings. Central to a high-performing team are principles of CRM and their timely application to stroke care. We review our paper in Neurocritical Care titled: "Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care" with three of the authors: Rajendram, Notario, Khosravani - In this episode we conclude this talk on "how to be a bad-a$$ stroke" resus doc!

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care by: Phavalan Rajendram, Lowyl Notario, Cliff Reid, Charles R. Wira, Jose I. Suarez, Scott D. Weingart & Houman Khosravani (Neurocritical Care, published in 2020) Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance Cliff's Great talk - Making Things Happen

AHA International Stroke Conference 2021

In this episode @neuroccm highlights three studies from #ISC2021 AHA's International Stroke Conference. We have the distinct privilege of having music by BreakMasterCylinder who has graciously contributed their compositions to our podcast focused on Stroke Education and awareness. We are most thankful - Please Follow @BrkmstrCylinder and contribute at Patreon.

Featured Studies:

ANGIO-CAT Study
"Nonetheless this represents an extremely exciting time, and the message should not be lost that patients with large vessel occlusions can be screened to some degree of reliance clinically and imaged using a flat panel CT with what appears to be a safe modality, and then be taken to thrombectomy and not be denied thrombolysis if needed. This study shows a major speed-up effect in workflow processes. It is quite possible that future studies with higher number of patients, in a multicenter setting, could tease out outcome differences as well. Therefore overall, this is an incredibly positive step forward - Our tools are only as good as the people able to deliver them, and this workflow improvement study certainly opens the door to further optimization of hyperacute stroke care." excerpt from a news piece by @neuroccm for Neurodiem.

BEST-MSU Study
"Taken together, 17% more patients were treated with TPA, the full 30% or more in the golden hour, with significantly improved patient-centered outcomes. There were 10% more patients with a modified Rankin score of 0 or 1 at 90 days. Overall, this is an important step forward in pushing the boundaries of bringing the treatment to the patient, and if this is ultimately found to be cost effective this represents yet another hyperacute innovation in acute stroke treatment. This may have specific relevance to both large, populated centers that are spread apart geographically, and certainly more austere environments as well." excerpt from a news piece by @neuroccm for Neurodiem.

MR CLEAN-NO-IV Study
Direct to EVT (early window) vs. Thrombolysis + EVT - designed as a superiority study. "They did not show superiorly nor non-inferiority of direct to EVT vs. combination treatment. There were no differences in symptomatic intracranial hemorrhage which is a particularly important finding, given that one could expect a higher rate with the TPA group. Dr. Yvo Roos, in a post-presentation interview with the AHA, suggest that hemorrhage rates may be more related to either delayed recanalization or simply that reperfusion itself is the main culprit for hemorrhage rather than onboard thrombolytic. This is provocative and needs further study and further details need to be reviewed. Certainly, there is biological plausibility and that patients are heterogeneous enough in their physiology and baseline neurovascular characteristics that reperfusion as a physiologic insult can result in such findings.

The important takeaway message here is that for patients that are eligible to receive thrombolysis – that thrombolysis should not be withheld in the era of thrombectomy, and thrombolysis should be delivered in a timely manner.

Taken together, there appears to be more science and understanding of criteria that are still necessary to be discovered with regards to which patient should go a stroke center capable of delivering thrombolysis versus directly to center that can provide comprehensive care with both modalities." excerpt from a news piece by @neuroccm for Neurodiem.