Simulation Methods in Acute Stroke Treatment

Kurz, Martin; Ospel, Johanna M.; Advani, Rajiv; Sandset, Else Charlotte; Aamodt, Anne Hege; Tennøe, Bjørn; Ersdal, Hege; Fjetland, Lars; Ajmi, Soffien Chadli; Kurz, Kathinka D.; Goyal, Mayank

doi:10.1161/strokeaha.119.026732

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…15 There is less experience with simulation as an assessment tool in the field of neurology despite a recent call to apply simulation methods to acute stroke treatment. 22 It has been shown to be an effective assessment and educational tool in brain death determination and status epilepticus. [23][24][25][26] In our study, there was an effect of level of training on performance, supporting validity of our simulation case as a sound performance measure.…”

Section: Discussionmentioning

confidence: 99%

Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke

et al. 2021

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Background and ObjectivesMultidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees’ education which in turn may contribute to poorer outcomes in community hospitals upon graduation. Our goal was to assess graduate neurology trainee performance independent of a multi-disciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)-related hemorrhage, and cerebral herniation syndrome.MethodsIn this prospective, observational, single-center simulation-based study, participants (sub-interns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was graduate neurology trainees’ critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training.ResultsFifty-three trainees (including 31 graduate neurology trainees) and five attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15/22 (68%). Ninety percent of graduate neurology trainees properly administered tPA, 84% immediately stopped tPA infusion following patient deterioration, but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean score [standard deviation (SD)] = 7.2 (2.8) vs. level 2 mean score (SD) = 12.3 (2.6) vs. level 3 mean score (SD) = 13.3 (2.2) vs. level 4 mean score (SD) = 16.3 (2.4), p < .001, R2 = 0.54).DiscussionGraduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke, but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

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Section: Discussionmentioning

confidence: 99%

Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke

et al. 2021

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“…Simulation training could almost certainly help to improve the skills of neurointerventionalists in MeVO EVT and prime them for frequently encountered technical challenges. 31 Unfortunately, at the moment, physician attitudes toward simulation are rather skeptical, and simulation training is regarded by neurointerventionalists as being useful for trainees only, despite ample evidence to the contrary. 32 Finally, the clinical impact of some frequently observed MeVO EVT complications is not entirely clear.…”

Section: Technical Considerations In Mevo Evtmentioning

confidence: 99%

Endovascular Treatment of Medium Vessel Occlusion Stroke

Ospel,

Nguyen,

Jadhav

et al. 2024

Stroke

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Approximately one-third of acute ischemic strokes with an identifiable vessel occlusion are caused by medium vessel occlusion (MeVO), that is, nonlarge vessel occlusions that are potentially amenable to endovascular treatment (EVT). Management of patients with MeVO is challenging in many ways: detecting MeVOs can be challenging, particularly for inexperienced physicians, and in busy clinical routine, MeVOs, therefore, remain sometimes undiagnosed. While the clinical course of MeVO stroke with medical management, including intravenous thrombolysis, is by no means, benign, it is more favorable compared with large vessel occlusion. At the same time, EVT complication rates are higher, and thus, the marginal benefit of EVT beyond best medical management is expected to be smaller and more challenging to detect if it were present. Several randomized controlled trials are currently underway to investigate whether and to what degree patients with MeVO may benefit from EVT and will soon provide robust data for evidence-based MeVO EVT decision-making. In this review, we discuss different ways of defining MeVOs, strategies to optimize MeVO detection on imaging, and considerations for EVT decision-making in the setting of MeVO stroke. We discuss the technical challenges related to MeVO EVT and conclude with an overview of currently ongoing MeVO EVT trials.

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“…3 Simulation team training has also been shown to improve team functioning-communication and cooperation of different members among a medical team. 4,5 This is particularly important for workflow in the neuroangiography suite because treatment delays at this stage will lead to delayed reperfusion and thereby directly affect patient outcome. It is important to establish continuous monitoring of treatment quality (eg, reperfusion quality and access site complications such as groin hematomas and infections following endovascular treatment) and workflow times (door-to-needle times, door-to-groin puncture times), particularly in a health care crisis, to ensure that treatment quality is maintained to the best of the ability of the system and to detect problems in EVT workflows and treatment quality early on, which grants the medical team the opportunity to intervene in a timely manner.…”

Section: Neuro-icu and Stroke Unitmentioning

confidence: 99%

Integrating New Staff into Endovascular Stroke-Treatment Workflows in the COVID-19 Pandemic

Goyal¹,

Kromm²,

Ganesh³

et al. 2020

AJNR Am J Neuroradiol

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A health care crisis such as the coronavirus disease 2019 (COVID-19) pandemic requires allocation of hospital staff and resources on short notice. Thus, new and sometimes less experienced team members might join the team to fill in the gaps. This scenario can be particularly challenging in endovascular stroke treatment, which is a highly specialized task that requires seamless cooperation of numerous health care workers across various specialties and professions. This document is intended for stroke teams who face the challenge of integrating new team members into endovascular stroke-treatment workflows during the COVID-19 pandemic or any other global health care emergency. It discusses the key strategies for smooth integration of new stroke-team members in a crisis situation: 1) transfer of key knowledge (simple take-home messages), 2) open communication and a nonjudgmental atmosphere, 3) strategic task assignment, and 4) graded learning and responsibility. While these 4 key principles should generally be followed in endovascular stroke treatment, they become even more important during health care emergencies such as the COVID-19 pandemic, when health care professionals have to take on new and additional roles and responsibilities in challenging working environments for which they were not specifically trained.

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Simulation Methods in Acute Stroke Treatment

Cited by 14 publications

References 28 publications

Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke

Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke

Endovascular Treatment of Medium Vessel Occlusion Stroke

Integrating New Staff into Endovascular Stroke-Treatment Workflows in the COVID-19 Pandemic

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