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

To investigate the frequency of stroke and code stroke activation and the factors influencing code stroke management in postoperative cardiac surgical patients.

A retrospective quality improvement study was conducted between January 1, 2016, and December 31, 2021.

The Cardiac Surgery Recovery Unit (CSRU) at London Health Sciences Centre in London, Ontario, Canada.

Postcardiac surgery patients aged 18 years or older who developed ischemic stroke during their admission to the CSRU.

No specific interventions were administered as part of this study. Code stroke activation mobilizes a specialized team. The objectives include assessment by a physician within 10 minutes, obtaining neuroimaging and interpretation within 45 minutes, and beginning treatment within 60 minutes.

The incidence rate of stroke in the CSRU was 1.3%, and 34% of these patients had code stroke activated. The time since the last known well status was 11 ± 8 hours. The most common reasons for not activating code stroke were not meeting both timing and clinical criteria. The average time for computed tomography (CT) scan was 36 ± 22 minutes. Among patients who had code stroke activated, 24% had large- vessel occlusion (LVO), and 67% of those with LVO had an established stroke on their initial CT.

Code stroke was activated in only one-third of patients who experienced a stroke following cardiac surgery. Additionally, out of those who had code stroke activated, only one-fourth were diagnosed with LVO. Among those with LVO, two-thirds were found to have a well-established stroke on noncontrast CT scans and were deemed ineligible for intervention.