Stroke priorities during COVID-19 outbreak: acting both fast and safe

Abstract

While the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads all over the world, the healthcare systems are facing the dramatic challenge of simultaneously fight against the outbreak and life-threating emergencies. In this biological setting, emergency departments and neurovascular teams are exposed to high risk of infection and should therefore be prepared to deal with neurological emergencies safely. The purpose of this article is to analyze the current evidence on COVID-19 in the context of acute ischemic stroke and to describe the model of behavior we are putting into action to maintain the stroke pathway both rapid for the patient and safe for the healthcare professionals. We reserve a specific focus on personal protection equipment, dress code and healthcare professional behavior.

Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity

“…This data confirmed that COVID-positive patients do not require an excessive burden of IR procedures, highlighting the aim of preserving a regular activity for non-COVID patients being able to protect both patients and healthcare workers. For this attempt, it is mandatory to follow procedural approaches for the IR workflow, creating different dedicated routes and facilities to reduce contamination, CT computed tomography, LDP lockdown period, min minutes, US ultrasound performing when possible bedside US-guided procedures to avoid moving and transporting suspected/positive patients out of their room/area [23], optimizing the use of appropriate personal protective equipment [24][25][26]. Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service up to now [27].…”

Acute Ischemic Stroke in COVID-19: Putative Mechanisms, Clinical Characteristics, and Management

“…This document provides guidance on prehospital stroke management based on robust stroke systems, emergency evaluation, and treatment, as well as general supportive care (readers are referred to the guideline for more information). Due to the time-dependent nature of acute ischemic stroke, current stroke guidelines recommend emergency care should be administered rapidly while avoiding any unnecessary time-wasting intervention [ 41 ]. All suspected stroke cases should have prompt brain imaging on hospital arrival, preferably within 20 mins of hospital arrival [ 40 ].…”

“…Stroke patients who meet the criteria should undergo rapid interventions with thrombolysis using recombinant tissue plasminogen activator (alteplase) and/or mechanical thrombectomy in those with large-vessel occlusion. Interventions should be carried out within the shortest possible time to limit brain damage [ 41 ]. This process of acute stroke care has been complicated since the emergence of COVID-19.…”

“…Patients who have a suspected or confirmed infection should be separated early. Where possible, this categorization should be carried out by the emergency medical services before arrival in the ED [ 41 ]. However, many stroke patients may be confused, aphasic, or unconscious, complicating the effort to determine the risk of infection.…”

“…If possible, remote assessment using telemedicine (telestroke) should be considered [ 40 , 45 ]. This allows the remote evaluation of radiological images as well as video-assisted neurological examination, thereby limiting the exposure of both healthcare professionals and patients [ 41 ]. Compared to the bedside assessment, telestroke has been shown to be effective in assessing the NIHSS score, as well as eligibility for thrombolysis and thrombectomy [ 45 ].…”