ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria

Area of Science:

• Neurology
• Critical Care Medicine
• Emergency Medicine

Background:

• Standard guidelines recommend ICU admission for ischemic stroke patients receiving IV-tPA.
• Recent trends expand eligibility for IV thrombolysis, including SMART criteria and transfer to comprehensive stroke centers (CSCs).

Purpose of the Study:

• To characterize ICU interventions in patients treated with a more liberal approach to IV-tPA.
• To determine if expanded IV-tPA criteria necessitate increased ICU resource utilization.

Main Methods:

• Retrospective review of consecutive transfer and non-transfer patients treated with sIV-tPA at a CSC.
• Evaluation of the frequency, timing, and nature of ICU interventions.

Main Results:

• 42% of sIV-tPA-treated patients required ICU interventions.
• 98% of those requiring interventions had them during triage, prior to ICU admission.
• Neither transfer to a CSC nor contraindications increased ICU interventions.

Conclusions:

• Liberalized IV-tPA administration does not increase ICU interventions.
• Triage assessment is highly sensitive in identifying patients needing ongoing ICU care.
• Early identification of ICU needs in triage can optimize inpatient placement and resource utilization.