2025 Southeastern Residency Conference

Comparison of Emergency Care Center and Mobile Stroke Unit Fibrinolytic Times in Resistant Hypertension Requiring Nicardipine
Authors: Kaitlyn Wallace, Andrew Yetka, Katleen Chester, Olivia Morgan
Background: 
Nicardipine is an intravenous antihypertensive medication often used for acute ischemic stroke (AIS) patients with acute hypertension resistant to IV push labetalol and/or hydralazine. Nicardipine is supplied as a premixed bag in the Grady Health System (GHS) mobile stroke unit (MSU) but must be compounded at bedside or in the main inpatient pharmacy when supplied in the emergency care center (ECC). The aim of this study was to analyze whether access to premixed nicardipine administered in the MSU shortens time to fibrinolytic administration in patients with resistant hypertension. 
Methods:
To analyze time to goal blood pressure for fibrinolytic therapy, a single center retrospective chart review was completed for patients treated with IV fibrinolytics within the Grady Health System for an AIS between May 10^th, 2021, and October 14^th, 2024. Patients treated with IV nicardipine prior to fibrinolytic administration in the ECC were compared to those treated similarly in the MSU. Patients younger than 18 years old, those presenting greater than 4.5 hours from symptom onset, and those who received a fibrinolytic for an indication other than stroke were excluded from analysis. The primary endpoint was time to fibrinolytic administration from the initial non-contrast computed tomography (CT) scan. Secondary endpoints included mean time to fibrinolysis from first antihypertensive medication, mean door (ECC) or arrival (MSU) to needle time, mean initial hypertensive blood pressure that excludes patient from fibrinolytic therapy, rate of symptomatic intracranial hemorrhage (ICH), and modified Rankin Scale (mRS) at discharge.
Results: 
A total of 39 ECC patients and 3 MSU patients were included in the final analysis. The median age was 63.5 years old, 52% of patients were male, and 81% identified as black or African American. Almost all patients had hypertension at baseline and the median National Institute of Health Stroke Score (NIHSS) was 7.5. Labetalol was the most used adjunctive agent, having been utilized in 64.3% of patients, and nicardipine alone was utilized in 33.3% of patients. The primary outcome of median CT-to-needle time was 33 minutes for the ECC and 35 minutes for the MSU. Door/arrival, 1^st antihypertensive, and nicardipine-to-fibrinolytic time were shorter favoring the MSU over ECC, though this was not statistically significant. 
Conclusions:
Within Grady Health System, intravenous nicardipine is not used frequently enough prior to IV fibrinolytics to draw statistically significant conclusions regarding faster times to fibrinolytic therapy in the MSU vs ECC.