Ischemic Stroke in the Cardiac Surgery Intensive Care Unit: A Quality Improvement Study

Objective: To investigate the frequency of stroke and code stroke activation and the factors influencing code stroke management in postoperative cardiac surgical patients. Design: A retrospective quality improvement study was conducted between January 1, 2016, and December 31, 2021. Setting: The Cardiac Surgery Recovery Unit (CSRU) at London Health Sciences Centre in London, Ontario, Canada. Participants: Postcardiac surgery patients aged 18 years or older who developed ischemic stroke during their admission to the CSRU. Interventions: No specific interventions were administered as part of this study. Code stroke activation mobilizes a specialized team. The objectives include assessment by a physician within 10 minutes, obtaining neuroimaging and interpretation within 45 minutes, and beginning treatment within 60 minutes. Measurements and Main Results: The incidence rate of stroke in the CSRU was 1.3%, and 34% of these patients had code stroke activated. The time since the last known well status was 11 +/- 8 hours. The most common reasons for not activating code stroke were not meeting both timing and clinical criteria. The average time for computed tomography (CT) scan was 36 +/- 22 minutes. Among patients who had code stroke activated, 24% had large- vessel occlusion (LVO), and 67% of those with LVO had an established stroke on their initial CT. Conclusion: Code stroke was activated in only one-third of patients who experienced a stroke following cardiac surgery. Additionally, out of those who had code stroke activated, only one-fourth were diagnosed with LVO. Among those with LVO, two-thirds were found to have a wellestablished stroke on noncontrast CT scans and were deemed ineligible for intervention. (c) 2024 Elsevier Inc. All rights reserved.