To assess safety and outcomes of immediate post-operative transferring of endovascular thrombectomy (EVT) patients to an external hospital ICU.

Due to the COVID-19 pandemic, hospital patient volumes increased significantly, resulting in a shortage of ICU beds in various NYC hospitals including the Mount Sinai Hospital system.  Patients in the system were often transferred within the network after mechanical thrombectomy was complete if bed availability at EVT site was unavailable.

Reviewed all consecutive EVT cases from January1 2020 – July 31 2021 at the Mount Sinai System for intersystem transfers. Out of the 353 thrombectomy cases that took place between this time frame, 27 patients were transferred to an outside ICU hospital. Patient demographics, co-morbid stroke risk factors (hypertension, diabetes, hyperlipidemia), stroke metrics such as modified rankin score, NIHSS, and TICI score were evaluated for each patient. Key safety outcomes were symptomatic hemorrhage (sICH), groin hematoma requiring manual compression, and unanticipated extubation or hemodynamic instability within the first 24 hours of transfer. Symptomatic ICH was defined as new intracranial hemorrhage associated with NIHSS increase >4 points.

Transferred patients were mostly male (n=18) with a mean age was 67.9 years. Twenty-five out of 27 (92.6%) patients achieved a TICI core of 2b or higher.  Major neurological improvement, defined as an NIHSS of 0-1 or ≥ 8 point improvement at 24 hours, was achieved in 51.8% of transfer patients. sICH occurred in 3 out of 27 (11%) of patients. There were no unexpected extubation or hemodynamic instability within the first 24hours. All transfer cases had a mRS of 0-3 upon discharge.  

Transfer post EVT to an outside hospital for close ICU monitoring is associated with 11% sICH risk without any apparent cardiopulmonary risk.