Device based prevention of neurological events in coronary artery bypass patients with calcified ascending aorta.

Patients with severely calcified aorta undergoing conventional cardiac surgery are at increased risk for postoperative neurologic deficits. Implementation of cerebroprotective devices may substantially reduce or even eliminate the risk of adverse neurologic event, thus enabling surgical therapy, especially when interventional treatment cannot be considered an alternative option.

A big white dot after CPR

Introduction Patients may remain comatose after the resumption of spontaneous circulation with cardiopulmonary resuscitation. A primary neurologic event may precede a cardiac standstill. Case report We present a 33-year-old patient with successful resuscitation for pulseless electrical activity and a “normal computed tomography (CT) scan.” Further scrutiny showed a hyperdense basilar artery sign (‘big white dot’) that led to a CT angiogram confirming an embolus to the proximal basilar artery. His examination showed fixed and dilated midsize (mesencephalic) pupils and extensor posturing. Endovascular retrieval of the clot was successful, but there was a devastating ischemic injury to the brainstem. Conclusion This case reminds us to consider neurologic causes of cardiac arrest.

Hospital complications among older adults: Better processes could reduce the risk of delirium

Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37–1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.

Arterial hypertension and cerebrovascular accidents. epidemiological profile of patients attended between 2013 and 2019 in Joinville, Santa Catarina, Brazil

Introduction: Cerebrovascular accident (CVA) is the second cause of death in the world, and arterial hypertension (AH) is the main risk factor. Objectives: To evaluate the prevalence of AH and the epidemiological profile of patients who suffered CVA, first and recurrent events, registered at JOINVASC, between 2013 and 2019. Methodology: An observational, descriptive, retrospective study, analyzing demographic data and risk factors, in patients that suffered CVA, first or recurrent event, was done. Results: In the study period, 6057 CVA events were registered, 4402(72.6%) patients were classified as hypertensive, (122 were excluded due to incomplete data), 4387 registers were analyzed. In this group, 2149 (51.2%) were male, mean age was 68.4±14.7(18 a 102 years), BMI was 27.5±5.1(14 a 59), 4330(39.9%) with Diabetes, 2559(58.8%) were smokers or ex-smokers, 3174(7.42%) were sedentary, and 504(11.5%) had controlled AH. In the group with recurrent event (1392-31.7%) (52.3%, p<0.001) were females, mean age was (69.4± 11.5) (p<0.002); BMI was lower (p=0.02). There was more cardiopathy (47.6%) (p<0,001) ,smokers or ex-smokers (66.2)(p<.005), diabetes (46.7%) (p<0.001) and deaths (32.3%)(p<0.001), less physical activity (22.0%)(p<0.001), use of antihypertensive drugs was greater (1.52±0,93)(p<0.001),. Logistic regression showed that female sex, BMI, DM, cardiopathy, physical activity, and more anti- hypertension drugs, were significant predictors for recurrence of neurologic event. Discussion: Despite advances in primary health care and prevention campaigns, the prevalence of AH in patients with CVA is high, and still has lowlevels of control, even in patients with recurrent CVA.

Arterial hypertension and cerebrovascular accidents. epidemiological profile of patients attended between 2013 and 2019 in Joinville, Santa Catarina, Brazil.

Introduction: Cerebrovascular accident (CVA) is the second cause of death in the world, and arterial hypertension (AH) is the main risk factor. Objetives: To evaluate the prevalence of AH and the epidemiological profile of patients who suffered CVA, first and recurrent events, registered at JOINVASC, between 2013 and 2019. Methodology: An observational, descriptive, retrospective study, analyzing demographic data and risk factors, in patients that suffered CVA, first or recurrent event, was done. Results: In the study period, 6057 CVA events were registered, 4402(72.6%) patients were classified as hypertensive, (122 were excluded due to incomplete data), 4387 registers were analyzed. In this group, 2149 (51.2%) were male, mean age was 68.4±14.7(18 a 102 years), BMI was 27.5±5.1(14 a 59), 4330(39.9%) with Diabetes, 2559(58.8%) were smokers or ex-smokers, 3174(7.42%) were sedentary, and 504(11.5%) had controlled AH. In the group with recurrent event (1392-31.7%) (52.3%, p<0.001) were females, mean age was (69.4± 11.5) (p<0.002); BMI was lower (p=0.02). There was more cardiopathy (47.6%) (p<0,001) ,smokers or ex-smokers (66.2)(p<.005), diabetes (46.7%) (p<0.001) and deaths (32.3%)(p<0.001), less physical activity (22.0%)(p<0.001), use of antihypertensive drugs was greater (1.52±0,93)(p<0.001),. Logistic regression showed that female sex, BMI, DM, cardiopathy, physical activity, and more anti- hypertension drugs, were significant predictors for recurrence of neurologic event. Discussion: Despite advances in primary health care and prevention campaigns, the prevalence of AH in patients with CVA is high, and still has low levels of control, even in patients with recurrent CVA.

Infective endocarditis and neurologic events: indications and timing for surgical interventions

A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.

Abstract WP460: Stroke Awareness is a 911: Stroke Team and EMS Collaboration for Stroke Education

Background: Accurate pre-hospital recognition of acute stroke is essential, but current training of EMS providers varies across agencies. We created targeted classes specifically for prehospital providers to increase their knowledge of stroke symptoms, emphasizing posterior circulating artery stroke (PCA) symptoms, with the goal to increase awareness of neurological emergencies and enhance patient destination decisions. Purpose: To enhance prehospital providers’ stroke knowledge, improve provider confidence levels of symptom identification and to help guide the prehospital providers with their stroke patient destination decision-making. Implementation process: Our stroke team collaborated with Beverly Hills Fire Department (BHFD). We created three educational modules using recorded stroke-specific paramedic calls that involved BHFD paramedics and Cedars-Sinai Mobile Intensive Care nurses. 77 EMS providers total attended the three classes. Each educational module outlined pathophysiology of stroke and reviewed treatment provided and final disposition of each case. Pre- and post-class knowledge assessment and evaluation Likert-scale surveys were distributed to each class participant. These surveys were collected and tallied. Results: Of 63 pre-class survey respondents, 25% felt definitely adequately trained and 54% felt somewhat adequately trained to recognize an acute ischemic neurologic event and felt somewhat likely to designate a patient as a Stroke Center candidate if their chief complaints coincided with PCA symptoms. Of 40 post-class survey respondents, 75% indicated that the class definitely augmented their previous training in recognizing an acute ischemic neurologic event, and 83% would very likely designate a patient as a Stroke Center candidate if their chief complaints coincided with PCA symptoms. Using Chi-square analysis, the improvement is stroke symptom confidence was statistically significant (p<0.01). Conclusions: The post-class surveys showed a substantial and statistically significant increase in the confidence levels of recognizing PCA symptoms in the field. Further studies will measure persistence of knowledge gained over time and extension of the educational modules to other agencies.