Institution of Code Neurointervention and Its Impact on Reaction and Treatment Times

Background/Objective—Various strategies have been implemented to reduce acute stroke treatment
times. Recent studies have shown a significant benefit of acute endovascular therapy. The JFK Comprehen‐
sive Stroke Center instituted Code Neurointervention (NI) on May 1, 2014 for the purpose of rapidly
assembling the NI team and rapidly providing acute endovascular therapy.
Design/Methods—We performed a retrospective analysis of all patients who had Code NI (Code NI
group) called from May 1, 2014 to July 30, 2018 and compared them to patients who underwent acute
endovascular treatment prior to initiation of the code (pre-Code NI group) between January 2012 and April
30, 2014. The following parameters were compared: door to puncture (DTP) and door to recanalization
(DTR) times, as well as preprocedure NIHSS, 24-hour postprocedure NIHSS, and 90-day modified Rankin
scores.
Results—There were 67 pre-Code NI patients compared to 193 Code NI patients. Mean and median DTP
times for pre-code NI vs Code NI patients were 161 minutes(mins) vs 115mins (p<0.0001, 31.76-58.86)
and 153mins vs 112mins (p <0.0001), respectively. Mean and median DTR times were 220 mins vs
167mins (p <0.0001, 37.76-69.97) and 225mins vs 171mins (p <0.0001). Mean pre-procedure NIHSS was
16 for both groups while 24 hours post procedure NIHSS was 10.6 vs 10.8 (p =.078, 1.8-2.38). Mean 90
day mRS was 2.15 vs 1.65 (p=0.036, 0.32-0.96).
Conclusion—Institution of Code NI significantly improved DTP and DTR times as well as mRS at 3-
months postprocedure. Rapid assembly of the NI team, rapid availability of imaging and angiography suite,
and streamlining of processes, likely contribute to these differences. These lessons and more widespread
institution of such codes will further aid in improving acute stroke care for patients.