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Related Experiment Video

Updated: Aug 6, 2025

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Multidisciplinary Stroke Pathway for Children Supported With Ventricular Assist Devices.

Sarah Lee1, Kathleen R Ryan2, Jenna Murray2

  • 1From the Department of Neurology & Neurological Sciences, Division of Child Neurology, Stanford University School of Medicine, Stanford, CA.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|March 14, 2023
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Summary

Developing a multidisciplinary stroke pathway significantly reduced time to CT imaging for children on mechanical circulatory support (MCS). This pathway addresses critical care gaps for pediatric ventricular assist device (VAD) patients experiencing stroke.

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Area of Science:

  • Pediatric Neurology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • Mechanical circulatory support (MCS), particularly ventricular assist devices (VADs), is a major cause of stroke in children.
  • Existing pediatric stroke guidelines are often inadequate for VAD-supported patients.
  • Timely and effective acute stroke care is challenging in this population due to specific barriers.

Purpose of the Study:

  • To develop a multidisciplinary pathway for acute stroke care in pediatric VAD patients.
  • To evaluate the early performance of this pathway in expediting stroke diagnosis and management.
  • To address identified barriers in stroke recognition and treatment for these children.

Main Methods:

  • Convened multidisciplinary stakeholders (pediatric heart failure, critical care, neurology, radiology, neurosurgery, pharmacy, VAD experts).
  • Identified challenges including delayed recognition, unclear imaging protocols, and antithrombotic reversal strategies.
  • Developed four specific acute stroke pathways for different clinical scenarios (pre-diagnosis, AIS, ICH, SDH).

Main Results:

  • Implemented stroke pathway significantly decreased median time-to-first-CT image by 43 minutes (from 66 to 23 minutes, P < 0.001).
  • Proportion of patients receiving a CT within 30 minutes increased from 0% to 67% (P < 0.001).
  • Multidisciplinary consensus was achieved despite identified challenges.

Conclusions:

  • A rapid stroke management pathway can be developed for children on VAD support.
  • The pathway effectively addresses key barriers to timely stroke care.
  • Pathway implementation led to significantly shorter time to initial CT imaging, improving diagnostic speed.