Stroke Care During the COVID-19 Pandemic: Asian Stroke Advisory Panel Consensus Statement

Abstract

The COVID-19 pandemic has impacted the health system worldwide. Stroke is one of the leading causes of death and disability in the world. Asia has a diverse health system and more than two-thirds of strokes occur in this region. The Asian Stroke Advisory Panel (ASAP) conducted a survey among the member countries to explore the impact of COVID-19 on stroke care. The stroke admission numbers have fallen, as have the number of patients who received thrombolysis and mechanical thrombectomy. The stroke unit and rehabilitation beds have been reallocated for COVID-19 care. ASAP recommends emergency department screening of stroke patients for COVID-19 and protected stroke code to be activated for COVID-19 suspect stroke patients. Noncontrast computed tomography (CT), CT angiography, and CT chest are the imaging modalities of choice. All health care professionals involved in triaging, imaging, and stroke care should wear appropriate personal protective equipment. All eligible stroke patients (COVID suspect/positive/non-COVID) should receive intravenous thrombolysis/mechanical thrombectomy. Mobile stroke units and robots can be used wherever available for evaluation and triaging. All stroke patients should receive standard stroke unit care. Limited rehabilitation should be offered to patients and training of caregivers if needed. Telemedicine/telestroke should be used for rehabilitation and follow-up. The ASAP consensus statement can be adapted to suit local and national health care systems.

Maintaining stroke care during the COVID-19 pandemic in lower- and middle-income countries: World Stroke Organization Position Statement endorsed by American Stroke Association and American Heart Association

“…Paramedical and emergency staff should wear appropriate personal protective equipment (PPE) while transporting patients. 7,9 Recommendations .…”

“…LMIC are encouraged to publish their individual protocols for a PCS with realistic adaptations such as those published by Indian Stroke Association and Asian Stroke Advisory Panel. 7,9 The use of tenecteplase for thrombolysis may be considered. However, services that choose to do so should consider substantial modifications to protocols.…”

“…An effort to provide the standard principles of SU care including the nursing care bundle (fever, sugar and swallow (FeSS) protocol), blood pressure (BP) and sugar control, and management of complications should be made for all stroke patients. 7,9 While COVID-19-negative patients should continue to receive care in designated SUs, intermediate-high risk and positive patients need to be managed in designated hospital areas, according to institutional protocols.…”

“…It is difficult to physically rehabilitate a patient without being in close contact with them; especially, patients with aphasia and hemiparesis. 7,9 Physical distancing might be impractical, and in patients requiring rehabilitation, we may need to screen for COVID-19. Even in COVID-19-negative patients, there is a need to reduce the duration of physical contact during each session of neurorehabilitation.…”

“…Follow-up should be arranged either in outpatient clinics or by telemedicine, with appointments provided at the time of discharge. 7,30 Recommendations .…”