Task Force 4: Inpatient Management of Patients with MCSD - The ...

All patients who note the development of a new neurologic deficit should be
quickly assessed by the MCS team in conjunction with neurologists or the acute stroke
team as soon as possible. In the intra-operative or early peri-operative period, delays in
detecting neurologic events can result, as they may not be evident until sedation is
weaned. Thus, it is critical to assess patients’ mental status early after arrival in the
intensive care unit and periodically thereafter until the patient is no longer sedated. The
assessment should include appropriate imaging as directed by the neurological team,
most often a CT scan of the head. In the setting of an embolic event that is diagnosed
shortly after the onset of presenting symptoms, angiography or vascular intervention
may be possible. The safety of thrombolytic therapy has not been established in the
MCS population, but it may be risk prohibitive in the peri-operative setting. An
assessment of the current INR as well as recent INR should also be performed. For
those with extracorporeal devices, the pump housing, the degree of emptying, and the
cannula should be inspected for clot formation. For those with continuous flow pumps,
the pump parameters should be reviewed for sign of pump malfunction or thrombus.
Recommendations for the Acute Management of Patients who Present with a New
Neurological Deficit:
Class I:
1. Assessment of current INR and review of recent INR is recommended.
Level of Evidence: B.
2. Prompt neurological consultation is recommended.
Level of Evidence: B.
3. Computed tomography and angiography of the head and neck is recommended.
Level of Evidence: B.
4. Review of pump parameters for signs of device thrombosis or malfunction is
recommended.
Level of Evidence: C.
5. Inspection of pump housing for clots in extracorporeal pumps is recommended.
Level of Evidence: C.
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