London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 673 616 Acute stroke: emergency management, stroke units and complications Developing a regional telestroke service: The South Yorkshire Experience K. R. Endean1, E.V. Hobson2, C Longford3, M.S. Randall4, G.S. Venables5 Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM1, Sheffield Institute for Transla-tional Neuroscience, Sheffield, UNITED KINGDOM2, North Trent Stroke Strategy Project, North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium (NORCOM)., Barnsley, UNITED KINGDOM3, Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM4, Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM5 Background With the importance of specialist stroke services and the benefits of thrombolysis in acute stroke clear it is becoming increasing important to provide rapid access to expert assessment and treatment for all patients 24 hours a day. In the UK, there are insufficient stroke physicians to provide resident services to provide such a specialist service. Methods A regional network of five hospitals (the North Trent Stroke Network) in South Yorkshire and North Derbyshire region (UK) developed a telemedicine service. The initial aim was to provide imme-diate access to a stroke physician outside working hours for patients considered for thrombolysis. The system enabled a video-consultation between the patient and physician using a laptop and their home broadband and review of radiology images. Results In the first 6 months of 2012 52% of patients presented out of hours (Monday to Friday 9am–5pm). 56 telemedicine consultations were conducted and 23 patients received thrombolysis. 40% of con-sultations occurred between midnight and 8am. Following thrombolysis one patient died from in-tracerebral haemorrhage but no clinical incidents occurred as a consequence of using telemedicine. Several life-threatening stroke mimics were also identified. Patient satisfaction was high. The only problems that prevented the use of the system were easily resolved with staff training and prepara-tion. Conclusion There is demand for out-of-hours specialist assessment and thrombolysis for acute stroke. A re-gional telemedicine service is a safe and cost-effective way of providing access to assessment and thrombolysis 24 hours-a-day. It may also be a means of providing better access to expertise in other areas of acute medicine. 617 Acute stroke: emergency management, stroke units and complications Critical cerebral oxygen supply? The impact of low hemoglobin levels and transfusion on criti-cal care patients with severe ischemic stroke L. Kellert1, F. Schrader2, P. Ringleb3, T. Steiner4, J. Bösel5 Department of Neurology, Universitiy Hospital Heidelberg, Heidelberg, GERMANY1, De-partment of Neurology, Universitiy Hospital Heidelberg, Heidelberg, GERMANY2, Department of Neurology, Universitiy Hospital Heidelberg, Heidelberg, GERMANY3, Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt, GERMANY4, Department of Neurology, Universitiy Hospi-tal Heidelberg, Heidelberg, GERMANY5 Purpose: Optimal hemoglobin (Hb) and red blood cell transfusion (RBCT) management is unknown in neurological intensive care unit (NICU) patients. Here we aimed to investigate the impact of ane-mia and transfusion activity in patients with acute ischemic stroke (AIS). Methods: Retrospective analysis of clinical, laboratory and outcome data of patients with severe AIS treated on our NICU between 2004 and 2011. Results: Of 109 patients, 97.2% developed anemia and 33% received RBCT. There were strong correlations between NICU length of stay (NICU LOS) and lowest (nadir) Hb (correlation coeffi-cient -0.42) and Hb decrease (0.52) as well as nadir hematocrit (Hct, -0.43) and Hct decrease (0.51). Duration of mechanical ventilation (MV) was strongly associated with both nadir Hb (-0.41) and decrease (0.42) and nadir Hct (-0.43) and decrease (0.40). RBCT correlated with NICU LOS (0.33) and with duration of MV (0.40). None of these hematologic parameters correlated with in-hospi-tal mortality or 90-day outcome. The regression model showed number of RBCT (0.24), nadir Hb (-0.18), Hb decrease (0.29), nadir Hct (-0.18), and Hct decrease (0.29) to be independent predictors of NICU LOS. Duration of MV was also independently predicted by number of RBC transfusions (0.29), nadir Hb (-0.20), Hb decrease (0.25), nadir Hct (-0.21), and Hct decrease (0.26). Conclusions: Low and further decreasing Hb and Hct levels as well as RBC transfusion activity are associated with prolonged NICU stay and duration of MV but not with mortality or longterm out-come. Our findings do not justify a more aggressive transfusion practice at present.
Karger_ESC London_2013
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