Optimizing mechanical thrombectomy – The impact of cath lab staff turnover on stroke thrombectomy times

Abstract

Background

Cath lab staff turnover increased dramatically after the COVID pandemic making it difficult to retain neurology-trained cath lab technicians (neuro-CLTs). We investigated the impact this had on local stroke quality metrics.

Methods

This is a retrospective study of a prospectively maintained thrombectomy (EVT) patient database at a single comprehensive stroke center from December 2021 through October 2023. Included patients underwent EVT for treatment of acute ischemic large vessel occlusion (LVO) stroke and had no missing outcomes data. Patients were grouped based on whether a neuro-CLT or non-neurology-trained CLT (other-CLT) was present for the procedure. Outcomes of interest included time from arterial access to the first EVT pass and time from cath lab arrival to arterial access.

Results

We observed a faster median time from access to first pass when working with neuro-CLTs (10 min IQR 7–15) compared to other-CLTs (15 min IQR 10–24, P = .004). We also observed a faster median time from CL arrival to access with neuro-CLTs (22 min IQR 17–29) compared to other-CLT (27 min IQR 20–34, P = .036). There was a greater likelihood of access to first pass time <10 min with neurology-trained techs (47% versus 25%, P = .009, OR 2.67).

Conclusion

Neurology-trained CLTs were associated with great efficiency in EVT workflow, saving a median of 10 min from cath lab arrival to first pass. Our data supports the development of organized training programs and competency standards for neuro-CLTs. Future prospective multi-center studies are necessary to establish external validity and the effect on patient outcomes.