Multidisciplinary Stroke Pathway for Children Supported With Ventricular Assist Devices

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.