Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams
Thanh N. Nguyen, Mohamad Abdalkader, Tudor G. Jovin, Raul G. Nogueira, Ashutosh P. Jadhav, Diogo C Haussen, Ameer E Hassan, Roberta Novakovic, Sunil A. Sheth, Santiago Ortega‐Gutiérrez, Peter D. Panagos, Steve M Cordina, Italo Linfante, Ossama Yassin Mansour, Amer M. Malik, Sandra Narayanan, Hesham Masoud, Sherry Chou, Rakesh Khatri, Vallabh Janardhan, Dileep R. Yavagal, Osama O. Zaidat, David M. Greer, David S. Liebeskind
Abstract
an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused an international outbreak.The World Health Organization designated this as a global pandemic on March 11, 2020, with over 200 countries affected worldwide.As of April 24, 2020, there were 2 790 986 patients with confirmed COVID-19 and 195 775 deaths worldwide, with the United States, Spain, Italy, France, Germany, United Kingdom, Turkey, and Iran surpassing China in the number of confirmed cases. 1 In a consecutive series of 221 patients with confirmed COVID-19 admitted to a hospital in Wuhan, China, acute ischemic stroke occurred in 11(5%) of patients with a broad range of stroke subtypes. 2These patients with stroke were older, more likely to have cardiovascular risk factors, presenting with severe COVID-19 with multiple organ involvement.Of note, presence of COVID-19 in these patients does not imply that COVID-19 was the mechanism leading to the patient's stroke.Shortages of Personal Protective Equipment (PPE) such as N95 masks, facial shields, hand sanitizer, and cleansing wipes have presented a major challenge in the allocation of resources, as healthcare workers are frontline in the treatment of these patients. 3Redeployment of clinical staff, nursing, stroke and neurocritical care specialists to care for patients with COVID-19 may create staffing shortages for dedicated stroke care.In an effort to mitigate the spread of COVID-19 to neuroscience healthcare workers, their patients, and their families, and to optimize allocation of healthcare resources, we present a modified algorithm to acute ischemic large vessel occlusion stroke workflow in the era of the COVID-19 pandemic.This guidance statement is based on shared best practices, 4-6 consensus among academic and nonacademic practicing vascular and interventional neurologists, literature review, and would be adapted to the available resources of a local institution.The patients with acute stroke are a vulnerable group to address because these patients often come emergently from the community with little information.Radical changes are felt to be necessary to optimize the safety of the providing team and our patients, limit unnecessary tests, conserve PPE resources and mechanical ventilator usage.This document divides into the following: prehospital phase to the Emergency Department (ED), prethrombectomy procedure, thrombectomy intraprocedure, and postreperfusion therapy phases (Table ).