Impact of COVID‐19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain

Abstract

Background and purpose Spain has been one of the countries more heavily stricken by SARS‐CoV‐2, which has had huge implications for stroke care. The aim was to analyse the impact of the COVID‐19 epidemic outbreak on reperfusion therapies for acute ischaemic stroke in the northwest of Spain. Methods This was a Spanish multicentre retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. All patients receiving reperfusion therapy for ischaemic stroke between 30 December 2019 and 3 May 2020 were recorded, and their baseline, clinical and radiological characteristics, extra‐ and intra‐hospital times of action, Code Stroke activation pathway, COVID‐19 status, reperfusion rate, and short‐term outcome before and after the setting of the emergency state were analysed. Results A total of 796 patients received reperfusion therapies for ischaemic stroke. There was a decrease in the number of patients treated per week (46.5 patients per week vs. 39.0 patients per week, P = 0.043) and a delay in out‐of‐hospital (95.0 vs. 110.0 min, P = 0.001) and door‐to‐needle times (51.0 vs. 55.0, P = 0.038). Patients receiving endovascular therapy obtained less successful reperfusion rates (92.9% vs. 86.6%, P = 0.016). COVID‐19 patients had more in‐hospital mortality. Conclusion A decrease in the number of patients benefiting from reperfusion therapies was found, with a delay in out‐of‐hospital and door‐to‐needle times and worse reperfusion rates in northwest Spain. COVID‐19 patients had more in‐hospital mortality.

Reductions in Hospital Admissions and Delays in Acute Stroke Care During the Pandemic of COVID-19

“…During the pandemic, one major negative impact on acute care for stroke was the decline in emergency hospital admissions, consistent with reports in different regions in China or other countries. The degree of reduction varied from 10 to 70% (11,13,13,(16)(17)(18)(19)(26)(27)(28)(29)(30)(31). One recent report in China also reported a 40% reduction in stroke hospital admissions (16), similar to our results (45.6%).…”

Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown

“…In contrast, ED stroke care delivery timeliness, such as DTN and DTG times, did not differ before and during the lockdown. Studies in Spain, one of the most heavily stricken countries by COVID-19, found a delay in prehospital and DTN times [ 10 , 31 ]. These findings partially differ from the analyses of major stroke care networks in the United States.…”

“…Also, the need to perform additional respiratory screening and use of personal protective equipment could increase prehospital delays. Another possibility could be the saturation of ambulance services or stroke alerts referred to other hospitals before being transferred to a stroke centre [ 10 ].…”

“…The consequences of stroke mimics may result in inappropriate usage of stroke care facilities and medical resources and increased workload on overwhelmed ED personnel [ 6 , 8 ]. A decreasing number of stroke admissions observed during the ongoing severe acute respiratory coronavirus 2 (SARS-CoV-2) outbreak causing the coronavirus disease 2019 (COVID-19) pandemic raised the concern of suboptimal prehospital identification and referral of acute illnesses [ 9 , 10 , 11 , 12 ].…”

Neurovaskuläre Manifestationen von COVID‑19

“…In Frankreich und Spanien zeigte sich in schwer betroffenen Regionen eine deutliche Zunahme der „Door-to-needle“-Zeit bei der intravenösen Thrombolyse bzw. der „Bild-zu-Leistenpunktionszeit“ bei der mechanischen Thrombektomie [ 14 , 32 ]. In einer Umfrage der European Stroke Organisation, auf die 426 Schlaganfallexperten aus 55 Ländern antworteten, wurden von 77 % der teilnehmenden europäischen Kollegen berichtet, dass nicht alle Schlaganfallpatienten die sonst übliche Versorgung in ihren Zentren erhalten konnten [ 1 ].…”