Ischemic Stroke in the Cardiac Surgery Intensive Care Unit: A Quality Improvement Study

Area of Science:

• Neurology
• Cardiology
• Quality Improvement

Background:

• Stroke is a serious complication following cardiac surgery.
• Timely intervention is crucial for improving outcomes in stroke patients.

Purpose of the Study:

• To determine the incidence of stroke and code stroke activation in postoperative cardiac surgical patients.
• To identify factors influencing code stroke management and treatment delays.

Main Methods:

• Retrospective quality improvement study (2016-2021) in a Cardiac Surgery Recovery Unit (CSRU).
• Analysis of postcardiac surgery patients (≥18 years) who experienced ischemic stroke.
• Review of code stroke activation criteria, neuroimaging times, and treatment eligibility.

Main Results:

• Stroke incidence was 1.3% in the CSRU.
• Code stroke was activated in 34% of stroke patients; common reasons for non-activation included unmet timing/clinical criteria.
• Among activated cases, 24% had large-vessel occlusion (LVO), with 67% showing established stroke on initial CT, often deeming them ineligible for intervention.

Conclusions:

• Code stroke activation remains underutilized in postcardiac surgery stroke patients.
• Barriers to activation include strict adherence to timing and clinical criteria.
• A significant proportion of LVO patients present with established strokes, limiting intervention options.