Life-Saving Acute Stroke Team Training
According to the American Heart Association Annual Statistical Update based on data compiled from over 190 countries, stroke remains the number 2 cause of death in the world. In the US, stroke is the number 4 cause of death, killing nearly 129,000 people a year. (1) Recent clinical studies have demonstrated for the first time that endovascular treatment (mechanical clot retrieval) can improve stroke patient outcome.(2) Currently, only 1% of ischemic stroke patients receive this costly but potentially life-saving treatment. Based on the positive outcome of these studies, the American Heart Association/American Stroke Association (AHA/ASA) has updated its guidelines on endovascular treatment for acute ischemic stroke, strongly recommending its use in certain patients (4). This has massive implications on how we are going to treat those patients with major endovascular occlusions in the future.

Prof. Iris Grunwald, Diagnostic and Interventional Neuroradiologist at Southend University Hospital, UK and Director of Neuroscience and Vascular Simulation at Anglia Ruskin University, UK, established an innovative interventional stroke service at Southend University Hospital.

THE CHALLENGE
“It is all about time and people knowing what to do from the moment the patient enters the hospital and the decision is taken to move the patient to the cath-lab and start the procedure,” believes Prof. Grunwald. “Especially in the crucial endovascular treatment step, there are so many people involved in the interventional stroke treatment – anesthesiologist, stroke physician, neurologist, cath-lab staff – a whole group of people who are not conventionally used to working together.” The challenge for Dr. Grunwald was how to train this group of professionals to work seamlessly together in the most efficient and effective way in performing the endovasular stroke treatment in the shortest amount of time. “We are now faced with the challenge of not having enough trained interventionalists especially interventional neuro-radiologists.”

An additional challenge was that stroke is an emergency procedure which makes it difficult for physicians in training to practice on the real patients.  “To practice this high risk procedure, I believe procedural training on a virtual reality simulator should be mandatory to provide an environment that is as close as possible to the actual setting when treating a patient.”

THE SOLUTION
Prof Grunwald strongly believes that “simulation training can save lives.” That is the guiding principle behind the Stroke Simulation Training Center at Anglia Ruskin University – Faculty of Medicine.

The simulation training center uses the 3D Systems ANGIO Mentor Suite for training physicians and their teams in complex stroke procedures. The principle benefits and advantages of the simulator for their simulation program are:

Team Training - A 4-Day Advanced Course was set up in which all the medical professionals from the Southend University Hospital go through repetitive training sessions not only in the field of stroke but how to deal with complications, carotid stenting, and aneurysm coiling. “Team Training was set up using the ANGIO Mentor Suite where we can simulate not only complex procedures but the whole pathway including anesthesia and patient management.” The ANGIO Mentor Suite allows for the reinforcement of non-technical skills in Team Training: enhancing communication skills, optimizing coordination and cooperation within the team and improving decision-making in both routine and emergency situations.” We also use video cameras during the simulation procedure so that different teams can watch how one of the team performs.” The ANGIO Mentor Suite simulator allows us to practice the stroke treatment procedure including complications as a team in a safe and controlled environment. “This realistic training for physicians and whole cathlab teams is especially important for stroke treatment. It unites the multidisciplinary team, defines individual roles, and allows an optimized flow of the work process."

Realistic Simulation - “We have been training physicians for many years in different models – sillicone, glass, animal models. None of these models gives you a realistic overview of the anatomy,” said Prof. Grunwald.  “The challenging part is not pulling out the clot but getting to the clot and for that anatomy plays the most important part.” The advantage of the ANGIO Mentor Suite is that it “replicates so accurately the real anatomy. Its simulation cases allows for practicing every step of the procedure again and again.”

Complications – Prof. Grunwald explains: “What I like about the simulator is although you have the possibility to trigger complications in the middle of a procedure, the simulator will also react to any mistakes the trainee does. I particularly like the complications feature because that is what makes all the difference, knowing how to deal with complications in an emergency and I want my team to have experience in seeing possible complications that may occur and deal with them in a stress-free environment before having to deal with them in a real setting.”

THE OUTCOME
Southend University Hospital found that running dedicated training courses in a true-to-life cath lab environment using a virtual reality simulator, enhanced the understanding of high-risk stroke procedures, strengthened collaboration and increased communication skills across the various clinical teams involved in this complex procedure. When it is “all about time and people knowing what to do when the decision is made to start the stroke procedure”, team training of all the medical professionals in the Stroke Treatment team on ANGIO Mentor Suite is essential part of this process.