Sharma Sonal, Dube Surya Kumar, Esmail Tariq, Hoefnagel Amie L, Jangra Kiran, Mejia-Mantilla Jorge, Shiferaw Ananya Abate, De Sloovere Veerle, Wright David, Lele Abhijit Vijay, Blacker Samuel Neal
Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
J Neurosurg Anesthesiol. 2025 Apr 1;37(2):196-205. doi: 10.1097/ANA.0000000000000976. Epub 2024 Jul 8.
This study explored the current global landscape of periprocedural care of acute ischemic stroke patients undergoing endovascular thrombectomy (EVT).
An anonymous, 54-question electronic survey was sent to 354 recipients in hospitals worldwide. The responses were stratified by World Bank country income level into high-income (HICs) and low/middle-income (LMICs) countries.
A total of 354 survey invitations were issued. Two hundred twenty-three respondents started the survey, and 87 fully completed surveys were obtained from centers in which anesthesiologists were routinely involved in EVT care (38 in HICs; 49 in LMICs). Respondents from 35 (92.1%) HICs and 14 (28.6%) LMICs reported that their centers performed >50 EVTs annually. Respondents from both HICs and LMICs reported low rates of anesthesiologist involvement in pre-EVT care, though a communication system was in place in 100% of HIC centers and 85.7% of LMIC centers to inform anesthesiologists about potential EVTs. Respondents from 71.1% of HIC centers and 51% of LMIC centers reported following a published guideline during EVT management, though the use of cognitive aids was low in both (28.9% and 24.5% in HICs and LMICs, respectively). Variability in multiple areas of practice, including choice of anesthetic techniques, monitoring and management of physiological variables during EVT, and monitoring during intrahospital transport, were reported. Quality metrics were rarely tracked or reported to the anesthesiology teams.
This study demonstrated variability in anesthesiology involvement and in clinical care during and after EVT. Centers may consider routinely involving anesthesiologists in pre-EVT care, using evidence-based recommendations for EVT management, and tracking adherence to published guidelines and other quality metrics.
本研究探讨了接受血管内血栓切除术（EVT）的急性缺血性中风患者围手术期护理的当前全球状况。
向全球医院的354名收件人发送了一份包含54个问题的匿名电子调查问卷。根据世界银行国家收入水平，将回复分为高收入（HICs）和低/中等收入（LMICs）国家。
共发出354份调查问卷邀请。223名受访者开始了调查，从麻醉医生常规参与EVT护理的中心获得了87份完整的调查问卷（HICs中有38份；LMICs中有49份）。来自35个（92.1%）HICs和14个（28.6%）LMICs的受访者报告称，他们的中心每年进行超过50例EVT手术。HICs和LMICs的受访者均报告麻醉医生参与EVT术前护理的比例较低，不过100%的HIC中心和85.7%的LMIC中心都有一个沟通系统，用于告知麻醉医生潜在的EVT手术。来自71.1%的HIC中心和51%的LMIC中心的受访者报告称，在EVT管理期间遵循了已发表的指南，不过两者使用认知辅助工具的比例都较低（HICs和LMICs分别为28.9%和24.5%）。报告了多个实践领域的差异，包括麻醉技术的选择、EVT期间生理变量的监测和管理以及院内转运期间的监测。质量指标很少被跟踪或报告给麻醉团队。
本研究表明，在EVT期间及之后，麻醉学参与情况和临床护理存在差异。各中心可考虑让麻醉医生常规参与EVT术前护理，采用基于证据的EVT管理建议，并跟踪对已发表指南和其他质量指标的遵守情况。
