Objective:

To evaluate the effectiveness of implementing a Code LVO (Large Vessel Occlusion) protocol based on the RACE (Rapid Arterial oCclusion Evaluation) score in a comprehensive stroke center in New Jersey. The study aimed to assess the impact on mechanical thrombectomy (MT) timing and LVO detection.

Background:

Acute ischemic stroke due to LVO is a time-sensitive medical emergency that requires rapid identification and treatment. The RACE score is a prehospital assessment tool designed to identify potential LVO cases quickly. However, the real-world impact of implementing RACE score-based protocols on treatment times and outcomes remains understudied.

Design/Methods:

A retrospective analysis was conducted on all Code LVO activations in 2022 and 2023. Code LVO criteria included:

• RACE score ≥ 5
• Disabling symptoms (aphasia, visual field cut, or total limb weakness)

Code LVO could be activated prehospital or in the emergency department. The protocol aimed to alert the neuro-interventional team before imaging to reduce:

• Door to team activation time
• Door to skin puncture time
• Door to device time
• Door to reperfusion time

The study compared MT patients with and without Code LVO activation

Results:

The analysis included a total of 105 patients who received MT, of which 31 had Code LVO activation and 74 did not. Clinical and demographic characteristics were similar between the two groups. The implementation of Code LVO activation resulted in significant improvements across all measured time metrics. Specifically, door to activation time decreased by 21 minutes, door to puncture time by 15 minutes, door to device time by 33 minutes; and the door to reperfusion time decreased by 39 minutes. All these time reductions were statistically significant (p < 0.05).

Conclusions:

Code LVO activation significantly reduced MT treatment times. However, the protocol was not activated for a substantial number of eligible patients, indicating on going challenges in implementing pre-hospital LVO screening tool.