Abstract Number ‐ 31: No Mercy on Stroke Campaign: The Use of Pop Culture Icons to Raise Stroke Awareness

Introduction About 24–46% of acute ischemic strokes are due to large vessel occlusions1, however only a small fraction2,3 of thrombectomy eligible patients undergo emergent clot retrieval. Despite advances in thrombolytics and endovascular interventions, many patients are not candidates for emergent therapies due to delay in patient presentation, prehospital delay, triage delay and limited access to care. No Mercy on Stroke (NMOS) campaign aims to raise public stroke awareness by increasing social media footprint. Thereby enabling the general population with tools for earlier symptom detection, seeking rapid medical attention and fighting for legislature to improve prehospital networks. Methods Society of Vascular and Interventional Neurology (SVIN) launched NMOS campaign just prior to World Stroke Day (WSD) on October 25th, 2021 via Twitter. Pop culture icon and martialist Martin Kove launched the campaign as Sensei Kreese from the movie Cobra Kai in a video encouraging viewers to “strike fast and strike hard” when treating stroke. SVIN and Kove urged followers to spread the fight against stroke by sharing karate poses with hashtag #NoMercyOnStroke. Metrics such as social media reach, impact, location and others were extracted via Tweepsmap and Tweetbinder from October 25th, 2021 to August 20th, 2022. Results #NoMercyOnStroke was tweeted 716 times by 211 contributors4 across 19 countries and 77 cities5 for a potential reach of 374,200 people and potential impact of 2,051,908 people4. Tweet breakdown consisted of 126 original tweets and 590 retweets4. Engagements were primarily likes recorded at 2437, and followed by 97 replies and 55 quotes. Activity timeline was highest during week of WSD and accounted for majority exposure, however, there was another small peak in activity one month later. Top 3 countries involved were USA, Canada and India although USA accounted for 90.4% of all activity. Other countries include Mexico, Colombia, Spain, Egypt, Croatia, UK, Saudi Arabia, Kenya, Libya, Vietnam, Italy, Cuba, France, Peru, Chile and Venezuela5. Top associated hash tags were #worldstrokeday, #WSD and #alz0212465. Conclusions Use of pop culture icon as an advocate for stroke awareness greatly increased reach and impression of the NMOS campaign by touching nearly two million followers. Compared to raw data across three social media platforms for a similar campaign by Mission Thrombectomy called #BEFASTChallenge, #NoMercyOnStroke had exponentially more engagement with almost double the original posts and triple the retweets. Still, activity was concentrated around initial launch with minimal tail in the activity timeline. The overall impact of such campaigns on the end‐goal of decreasing the ratio of eligible thrombectomies to number of thrombectomies performed is yet to be uncovered. However, it is clear that larger campaigns involving celebrity influencers and community outreach are imperative to keeping the momentum of raising stroke awareness

Abstract Number ‐ 100: Hypothermia As A Therapy For Status Epilepticus: Systematic Review And Description Of A Novel Technique

Introduction Refractory status epilepticus (RSE) is seizure lasting longer than 1 hour1 or response failure to one benzodiazepine and one AED2,3. Unfortunately, 30% of patients remain refractory to two AEDs and 15% to three AEDs4. Next line of therapy is intravenous anesthetic drugs (IVADs) which successfully control RSE in majority cases. Still, 15–35% of RSE progresses to super refractory status epilepticus (SRSE)1, defined as sustained seizure greater than 24 hours despite IVADs or recurrent seizure during IVAD weaning5,6. IVADs are associated with increased mortality due to adverse effects of respiratory depression, cardiac compromise and hypotension7. Therefore, alternative treatment such as focal hypothermia is being explored6. Older studies using ventricular irrigation8, extravascular irrigation9 and combination of local and systemic cooling10 demonstrated efficacy of focal cooling to suppress seizures. Recent literature describes use of focal cooling via thermoelectric devices for refractory focal epilepsy11. Choi et al. successfully trialed intracarotid cold saline infusions during cerebral angiography as an endovascular approach for focal hypothermia12. Chen et al. demonstrated the safety of intra‐arterial selective brain cooling in acute ischemic stroke13. This review summarizes studies demonstrating efficacy of hypothermia and introduces a novel technique for seizure suppression in SRSE. Methods Literature search of PubMed and Google Scholar was performed for hypothermia for SE. Variables such as etiology and type of SE, number of AEDs, anesthetic used, method to achieve hypothermia, target temperature, induction time, time at target temperature, time to rewarm and seizure response were extracted. Results Twelve out of 15 recruited studies used external cooling to achieve hypothermia while 2 studies with total 9 subjects used endovascular cooling. Corry et al. used endovascular cooling only while Ren et al. combined endovascular and external cooling, both used concurrent IVADs. Complications included shivering, post‐rewarming seizures, metabolic derangements, coagulopathy, thromboembolism, arrythmia, infection/sepsis and death collectively. Burst suppression or seizure cessation was achieved in all 9 patients. Outcomes ranged from discharged seizure‐free to poor Glasgow Outcome Scores. Conclusions Patients with SRSE may benefit from a trial of hypothermia. Although major complications of hypothermia were reported, concurrent use of IVADs may confound true morbidity of hypothermia alone. Currently available studies suggest an endovascular approach for focal hypothermia may be more effective, efficient and safer12‐15. Endovascular hypothermic cortical irrigation as a novel technique to abort refractory seizures may be a quicker therapeutic option with minimal adverse effects. In this technique, 4C cold heparinized saline is administered to the vascular territory of the epileptiform region as identified on intraoperative encephalography (EEG). Efficacy of treatment can be observed immediately as suppression or change of seizure activity on EEG. Focal hypothermia in the form of selective intra‐arterial treatment is a potential therapeutic target that needs further studies to validate its safety and feasibility