Current Recommendations for the Management of Stroke Patients in the Middle East in the Era of COVID-19 Pandemic; Statement from the MENA SINO

Abstract

COVID-19 pandemic has led to a change in the way we manage acute medical illnesses. This pandemic had a negative impact on stroke care worldwide. The World Stroke Organization (WSO) has raised concerns due to the lack of available care and compromised acute stroke services globally. The numbers of thrombolysis and thrombectomy therapies are declining. As well as, the rates and door-to treatment times for thrombolysis and thrombectomy therapies are increasing. The stroke units are being reallocated to serve COVID-19 patients, and stroke teams are being redeployed to COVID-19 centers. Covid 19 confirmed cases and deaths are rising day by day. This pandemic clearly threatened and threatening all stroke care achievements regionally. Managing stroke patients during this pandemic is even more challenging at our region. The Middle East and North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) is the main stroke organization regionally. MENA-SINO urges the need to developing new strategies and recommendations for stroke care during this pandemic. This will require multiple channels of interventions and create a protective code stroke with fast triaging path. Developing and expanding the tele-stroke programs are urgently required. There is an urgent need for enhancing collaboration and cooperation between stroke expertise regionally and internationally. Integrating such measures will inevitably lead to an improvement and upgrading of the services to a satisfactory level.

Neurological Complications of COVID-19: Underlying Mechanisms and Management

“…The increased risk of hypercoagulable states has resulted in the suggested addendums for COVID-19 patients at risk of cerebral vascular incidents. [ 107 , 108 , 109 , 110 ]. The documented endothelial injury, changes in circulating prothrombotic factors, and increased stasis resulting from immobilization due to COVID-19 infection have warranted hypervigilance in the monitoring and prophylactic treatment of these patients.…”

Penanganan Stroke Iskemik Akut di Masa Pandemi COVID-19

“…Ketika pasien harus segera dibawa ke rumah sakit maka petugas EMS harus memberitahukan terlebih dahulu rumah sakit yang dituju tentang kondisi pasien termasuk status COVID-19 yang dimiliki pasien agar rumah sakit sudah siap terlebih dahulu sebelum pasien datang. 5,8,9 Proses pengangkutan pasien stroke juga harus segera dengan mengikuti onset-todoor time ≤3 jam, door-to-imaging time ≤25 menit, dan door-to-needle time ≤60 menit. 15 Tahapan kedua ialah tahap hospitalisasi.…”

“…12 Pada pengaturan di CT room usahakan agar ruang CT scan pasien COVID-19 dan bukan COVID-19 dibuat terpisah. 8 Identifikasi pasien untuk trombektomi dapat berupa evaluasi secara klinis dan CT scan berbasis kontras seperti CT angiography (CTA) dan CT perfusion (CTP) dengan melakukan evaluasi ginjal terhadap penggunaan kontras terlebih dahulu. 7 Namun pasien akan menunggu hasil skrining COVID-19 dengan dipantau oleh tim stroke di area khusus jika tidak ada indikasi untuk trombektomi.…”

“…10 Dalam ruangan ini juga sebaiknya dibatasi jumlah kunjungan untuk meminimalkan risiko penularan dan mencegah pemborosan APD. 8 Apabila stroke iskemik disebabkan oleh oklusi pembuluh darah besar maka pasien akan melakukan pengobatan endovaskular di Unit Neuroradiologi dengan memperingatkan agar para petugas yang menanganinya menggunakan APD yang memadai. 10 Trombektomi endovaskular sebaiknya dilakukan dengan sedasi sadar.…”

“…Tahap tiga ini bertujuan untuk mengadakan sebuah program yang dapat membahas tentang pemeriksaan harian pada tim stroke, edukasi pasien dan keluarga, perencanaan pulang dan dukungan setelah pulang, termasuk didalamnya follow up pasien yang dapat dilakukan melalui konsultasi melalui telestroke. 4,8…”