1. Stroke and Neuro-Intensive Care at OHSU
Helmi L. Lutsep, MD
Oregon Stroke Center
Oregon Health & Science University

2. Approved/Cleared Acute Stroke Treatments
IV tPA up to 3 hrs (4.5 hrs per Science Advisory) after symptom onset
Merci Retrievers and Penumbra System in large vessel occlusions generally up to 8 hrs after symptom onset
Can treat patients that are not IV tPA eligible
Can treat patients with residual clot after IV tPA

3. INR Activation Volume 7-09 to 4-11

4. Stroke Volume OHSU

5. Stroke Code Team Transfer center Stroke MD INR MRI Neurosci ICU
Stroke coordinator, research assistant
Transfer center
INR
MRI
Anesthesia, rapid response
Neurosci ICU
Neurosurgery

6. Telemedicine/Telestroke
OHSU consultant
Obtains patient history, observes exam
Views images via teleradiology
Discusses management with local provider

7. Telemedicine: OHSU Stroke
Mid-Columbia
OHSU
Mercy
Columbia Memorial
Adventist
Willamette Valley
Salem Hospital 2011
Rogue Valley 2011

8. Stroke Code Team Transfer center Stroke MD INR MRI Neurosci ICU
Stroke coordinator, research assistant
Transfer center
INR
MRI
Anesthesia, rapid response
Neurosci ICU
Neurosurgery

9. OHSU Acute Stroke Team Stroke Neurologists Clark, W Lutsep, H
McDaneld, L
Nurses, Coordinators
Dolan, M
Foley, J
Jamison, S
Larson, D
Seisler, K
Research Assistants
Feest, K
Gard, L
Spriggs, K
Tilden, N

10. OHSU Clinical Stroke Trials
CREST OHSU VA 6
Carotid Revascularization Endarterectomy versus Stenting Trial (CREST)

11. Patient Case: 68 Year-Old Man
Patient last known normal at 2:30 AM but awoke at 6:00 AM with left hemiparesis, right gaze preference
At outside ED he is outside of tPA window
NIHSS=21
Transferred for embolectomy 5 hours after last known normal

12. Stroke Code Team Transfer center Stroke MD INR MRI Neurosci ICU
Stroke coordinator, research assistant
INR
Transfer center
MRI
Anesthesia, rapid response
Neurosci ICU
Neurosurgery

13. Patient Case: 68 yo Baseline NIHSS=21
DEFUSE 2
Imaged 5 hrs post last known normal

14. M1 Occlusion Pre and Post Embolectomy
Pre Treatment
Post mechanical embolectomy with Solitaire device as part of SWIFT trial:
Revascularized (TICI 3) at 8 hrs 40 min post last known normal

15. Patient Case: Post Treatment Imaged 12 hrs Post Last Known Normal

16. Stroke Code Team Transfer center Stroke MD INR MRI Neurosci ICU
Stroke coordinator, research assistant
Transfer center
INR
MRI
Anesthesia, rapid response
Neurosci ICU
Neurosurgery

17. Patient Case: 68 Year-Old Man
Patient observed for edema in neuro ICU , treated for urinary tract infection
Discharge NIHSS=4
Day 30 NIHSS=2

18. 17 Beds

19. Neurocritical Care at OHSU
October 2006
Dedicated space = Neuroscience Intensive Care Unit 7NSICU
Admission of neurosurgical and neurology patients
Team expansion (residents, fellows, PAs)
24/7 in-house coverage

20. OHSU NSICU Patient Population
Neurosurgery (~75%)
SAH (aneurysmal, AVM)
ICH (IPH + IVH)
Tumor surgery
Hydrocephalus (+ infect)
SDH
Spine surgery
INR procedures
Neurology (~25%)
Ischemic stroke, TIA
Neuromuscular disease
Seizures
Encephalitis
Meningitis

21. Multidisciplinary Approach
Neurocritical care nurse
Respirator therapist
Neurointensivist
Neurosurgeon
Neurologist
Interventional neuroradiologist
Pharmacist
Physiotherapist
Occupational therapist
Speech therapist
Social worker
Case manager
Consultant(s) (eg. Cardiology, Infectious Disease, Anesthesiology, Radiology, Nephrology, Endocrinology, Palliative Care, etc.)
Truly comprehensive care
of patients suffering from
nervous system disorders
and who are critically ill

22. OHSU Neurocritical Care Service, Patient Volume / Month
(n=9546 patient days / last 19 months)
continuous
overflow into
other units
2008
2009 (n=5807)
2010

23. OHSU’s Neurocritical Care Service
Provides the only specialized ICU in Oregon for patients suffering from nervous system disorders and who are critically ill
Offers unique diagnostic and interventional opportunities for further evaluation and treatment
Features dedicated individuals with outstanding expertise and the ultimate ambition for excellence in ICU care