Stroke FM

In this episode @neuroccm highlights three studies from #ISC2021 AHA's International Stroke Conference. We have the distinct privilege of having music by BreakMasterCylinder who has graciously contributed their compositions to our podcast focused on Stroke Education and awareness. We are most thankful - Please Follow @BrkmstrCylinder and contribute at Patreon. Click here to see the studies discussed in this episode.

AHA International Stroke Conference 2021

In this episode @neuroccm highlights three studies from #ISC2021 AHA's International Stroke Conference. We have the distinct privilege of having music by BreakMasterCylinder who has graciously contributed their compositions to our podcast focused on Stroke Education and awareness. We are most thankful - Please Follow @BrkmstrCylinder and contribute at Patreon.

Featured Studies:

ANGIO-CAT Study"Nonetheless this represents an extremely exciting time, and the message should not be lost that patients with large vessel occlusions can be screened to some degree of reliance clinically and imaged using a flat panel CT with what appears to be a safe modality, and then be taken to thrombectomy and not be denied thrombolysis if needed. This study shows a major speed-up effect in workflow processes. It is quite possible that future studies with higher number of patients, in a multicenter setting, could tease out outcome differences as well. Therefore overall, this is an incredibly positive step forward - Our tools are only as good as the people able to deliver them, and this workflow improvement study certainly opens the door to further optimization of hyperacute stroke care." excerpt from a news piece by @neuroccm for Neurodiem.
BEST-MSU Study"Taken together, 17% more patients were treated with TPA, the full 30% or more in the golden hour, with significantly improved patient-centered outcomes. There were 10% more patients with a modified Rankin score of 0 or 1 at 90 days. Overall, this is an important step forward in pushing the boundaries of bringing the treatment to the patient, and if this is ultimately found to be cost effective this represents yet another hyperacute innovation in acute stroke treatment. This may have specific relevance to both large, populated centers that are spread apart geographically, and certainly more austere environments as well." excerpt from a news piece by @neuroccm for Neurodiem.

MR CLEAN-NO-IV StudyDirect to EVT (early window) vs. Thrombolysis + EVT - designed as a superiority study. "They did not show superiorly nor non-inferiority of direct to EVT vs. combination treatment. There were no differences in symptomatic intracranial hemorrhage which is a particularly important finding, given that one could expect a higher rate with the TPA group. Dr. Yvo Roos, in a post-presentation interview with the AHA, suggest that hemorrhage rates may be more related to either delayed recanalization or simply that reperfusion itself is the main culprit for hemorrhage rather than onboard thrombolytic. This is provocative and needs further study and further details need to be reviewed. Certainly, there is biological plausibility and that patients are heterogeneous enough in their physiology and baseline neurovascular characteristics that reperfusion as a physiologic insult can result in such findings.

The important takeaway message here is that for patients that are eligible to receive thrombolysis – that thrombolysis should not be withheld in the era of thrombectomy, and thrombolysis should be delivered in a timely manner.

Taken together, there appears to be more science and understanding of criteria that are still necessary to be discovered with regards to which patient should go a stroke center capable of delivering thrombolysis versus directly to center that can provide comprehensive care with both modalities." excerpt from a news piece by @neuroccm for Neurodiem.

In this episode, two keen Resident MDs Drs. Ryan Muir (PGY4) and Jaime Cazes (PGY1) join us for an in-depth at how things are going! A recent look back from within the 2'nd wave of COVID (in Canada), which thankfully is subsiding. They provide insight into how COVID has impacted their residency training, what our program has done, and how new learning opportunities have manifested in the form of Virtual Care. #TakeCare Everyone and keep looking out for your #Wellness as we look forward to better days!

Don't miss the conclusion of the 2 part episode on Crisis Resource Management (CRM). Click here for the details on this episode.

Did you ask about thrombolysis? We are here to deliver anxiolysis! In this second of a two-part episode of 2021, we discuss "crisis resource management" (CRM) in acute stroke - a cognitive, mindfulness, and non-technical framework for optimizing clinical performance and working in high-performing teams. CRM is a tool to master four operational domains: that of the self, teamwork, our working environment, and of course, (care for) our patient. Using CRM principles helps make us better clinicians, work more effectively in teams, and maintain a calm sense of vigilance. We re-introduce the concept of a "zero point survey" (Reid et al. 2018) as a starting point before coming on-call for a code stroke and as a tool for better self-awareness and performance. High-performing teams support good clinical outcomes at the resuscitation phase and apply to all subsequent patient care settings. Central to a high-performing team are principles of CRM and their timely application to stroke care. We review our paper in Neurocritical Care titled: "Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care" with three of the authors: Rajendram, Notario, Khosravani - In this episode we conclude this talk on "how to be a bad-a$$ stroke" resus doc!

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care by: Phavalan Rajendram, Lowyl Notario, Cliff Reid, Charles R. Wira, Jose I. Suarez, Scott D. Weingart & Houman Khosravani (Neurocritical Care, published in 2020) Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance Cliff's Great talk - Making Things Happen

In this first of a two-part episode, we discuss Crisis Resource Management (CRM) in acute stroke. Click here to learn more about high performing teams in hyperacute stroke care.

Did you ask about thrombolysis? We are here to deliver anxiolysis! In this first of a two-part episode of 2021, we discuss "crisis resource management" (CRM) in acute stroke - a cognitive, mindfulness, and non-technical framework for optimizing clinical performance and working in high-performing teams. CRM is a tool to master four operational domains: that of the self, teamwork, our working environment, and of course, (care for) our patient. Using CRM principles helps make us better clinicians, work more effectively in teams, and maintain a calm sense of vigilance. We re-introduce the concept of a "zero point survey" (Reid et al. 2018) as a starting point before coming on-call for a code stroke and as a tool for better self-awareness and performance. High-performing teams support good clinical outcomes at the resuscitation phase and apply to all subsequent patient care settings. Central to a high-performing team are principles of CRM and their timely application to stroke care. We review our paper in Neurocritical Care titled: "Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care" with three of the authors: Rajendram, Notario, Khosravani

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care by: Phavalan Rajendram, Lowyl Notario, Cliff Reid, Charles R. Wira, Jose I. Suarez, Scott D. Weingart & Houman Khosravani (Neurocritical Care, published in 2020) Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance

Greetings Stroke FM listeners. We are back in 2021 with an exciting series of Podcasts, follow-up episodes, clinical and non-technical discussions and new future partnerships. Looking forward to releasing episodes as we record them this year and moving onwards! Take care + stay safe!

In this episode the hosts discuss the future of stroke. Click here to see the details.

Key Terms: Thrombolysis, endovascular therapy,

Hosts: Ryan Muir, Houman Khosravani

Summary:

In this episode the hosts discuss the future of stroke by exploring and proposing novel applied modern concepts of endovascular and thrombolytic therapies to innovative and creative ideas for the future.

• Endovascular therapy for distal vessels is discussed

• Improving geographic access to endovascular therapy (especially for wide spread countries like Canada)

• The role of the NIHSS score in the acute assessment of stroke in the future and the increasing reliance on imaging parameters to guide decision making

• The future of thrombolysis

• The future of neuroimaging: Evolving understanding of ASPECTS and MRI Brain (Solid state MRI in acute stroke assessments), and potential role for focused ultrasound

• Neuroprotection and extending time-windows

Tune in to hear the hosts talk about residency, mentorship, work-life balance and more. Click here to see the details.

Key Terms: Transition to residency, Work-life balance, Mentorship, Surviving PGY1

Hosts: Sydney Lee, Jaime Cazes and Houman Khosravani

Summary:

• First few days of residency

• Managing expectations

• Discovering the rewards of residency

• Going from off-service to on-service

• Balancing residency with lifestyle

• Mentorship

• Surviving call

• Three take home points

1. A positive attitude will take you far

2. Reach out to your fellow residents

3. Enjoy yourself as much as possible

In this episode the hosts discuss stroke orientation during the COVID-19 pandemic. Click here to see the details.

Key Terms: COVID-19, Stroke Orientation, NVU

Hosts: Jane Liao, Houman Khosravani

Summary:

• Purpose of modified procedures - Limit human-human interaction

• Handover in separate rooms

• Limit hand-off of items (pager, tools) and wipe down after doing so

• Virtual meeting apps (Zoom, Google Meet) for rounds/teaching when possible

• Have a moderator for meetings focused on keeping discussions concise

• Send residents home early if the day's tasks are complete and they are not needed

• Assign only one resident to go with the staff to stroke codes as opposed to the whole team

• https://www.codestroke.net/covid19

In this episode the hosts talk about Protected Code Stroke (PCS), which provides a framework for safely and efficiently delivering hyperacute stroke care.

Key Terms: Protected Code Stroke, COVID-19, Personal Protective Equipment

Hosts: Phavalan Rajendram, Jaime Cazes, Houman Khosravani

Summary:

• The COVID-19 pandemic poses unique challenges in delivering hyperacute stroke care

• The “Protected Code Stroke” (PCS) protocol provides a framework for safely and efficiently delivering hyperacute stroke care

• Know when to activate a PCS

• Always use PPE with correct donning & doffing techniques

• Always appoint a safety leader

• Use crisis resource management principles

This episode covers how COVID-19 has impacted healthcare and medical education from the viewpoints of a graduating 4th year medical student and a staff physician.

• Key Terms: COVID-19, PPE, Pandemic, medical education

• Hosts: Jaime Cazes, Houman Khosravani

• Summary:

• This episode covers how COVID-19 has impacted healthcare and medical education from the viewpoints of a graduating 4th year medical student and a staff physician.