Abstract 222: Immediate post thrombectomy extubation is associated with improved clinical outcomes

Abstract

Introduction Recent findings suggest that general anesthesia with endotracheal intubation (GA) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) who receive mechanical thrombectomy (MT) is associated with similar outcomes to conscious sedation (CS). [1][2] However, these trials involved stroke specific GA protocols in which immediate, post‐operative extubation was emphasized. In this study, we investigated outcomes of MT in AIS due to LVO as a function of the timing of extubation and explored variables that could delay extubation. Methods We performed a retrospective analysis of collected data gathered during a 5‐year period (2018‐2022) for all our patients with AIS due to LVO who received MT. We analyzed the stroke outcomes and complications between patients who had received GA and those who had received CS. We also investigated the relationships between associated pulmonary risk factors, timing of extubation, and tracheostomy, on the outcomes of stroke. Results A total of 242 patients were included in our study. 83 patients received GA and 159 patients received CS. Our study shows CS in MT had a 2.74 (95% CI = 1.21‐6.22) higher odds of having a final TICI rating of 0‐2a compared to those who had GA. A logistic regression model was fitted that included NIHSS prior to MT; in this analysis, patients who received GA had 2.71 times higher odds of reaching TICI 2b or higher (OR = 2.71, 95% CI = 1.19‐6.17). NIHSS was not a significant predictor of recanalization in our patients. Patients extubated in the IR suite vs. elsewhere (excluding patients who were not extubated in hospital) had 3.82 (95% CI = 1.03‐14.18) times higher odds of having an excellent mRS at 90 days (n=65). Those extubated late had higher odds of transitioning to comfort care (OR=4.50, 95% CI = 1.52‐13.31, p=0.004), and 90‐day mortality (OR=5.49, 95% CI = 1.71‐17.65, p=0.002). Those who were extubated early had a lower NIHSS post MT (mean = 10.89 vs 19.18), t=‐5.79, p<0.001), and a lower NIHSS at discharge (mean = 9.20 vs 17.11), t=‐5.79, p<0.001). There were no significant correlations between history of COPD or the BMI and the timing of extubation or the outcomes of MT. In addition, COPD was not associated with any significant changes in discharge or 90 days mRS. Conclusion Administration of GA to patients who receive MT for AIS was associated with better outcomes in our cohort. Immediate extubation was associated with better outcomes than delayed extubation in the GA group. A history of COPD or high BMI should not affect the decision to provide with GA for MT.