Protected Stroke Mechanical Thrombectomy Code During the Coronavirus (COVID-19) Pandemic: Southwestern Part of Saudi Arabia Stroke Unit Local Protocol

Abstract

Cerebrovascular diseases are a significant cause of mortality and morbidity worldwide, in particular those with large vessels occlusion (LVO). Coronavirus disease 2019 (COVID-19) has become a global crisis rapidly since its initial outbreak in Wuhan, China, in December, 2019. Stroke due to LVO needs rapid assessment and timely endovascular intervention which can be very challenging during the time of pandemic where you need to deliver proper, safe, and timely care to acute ischemic stroke (AIS) patients with LVO, yet, protecting healthcare workers and existing patients at the medical facility. In this article, we share our local experience in the stroke unit at Aseer Central Hospital which is the main hub of stroke patients in the southwestern part of Saudi Arabia and the primary regional COVID center to provide guidance to perform smooth, safe, and swift mechanical thrombectomy during the coronavirus (COVID-19) pandemic as well as possible similar future situations.

Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom

“…The patient demographics were similar between the 2 groups, with no significant differences in the admission NIHSS (18)(19)(20)(21) or Glasgow Coma Scale (13)(14) vs. [13][14][15], p = 0.337). There was a nonsignificant drop in the proportion of stroke thrombectomy patients referred from external hospitals from 82 to 61% during the CO-VID-19 pandemic (p = 0.067).…”

“…At the same time, several professional bodies issued temporary emergency guidance for the COVID-10 pandemic and recommended that every new stroke admission should be treated as potentially infected [ 13 ]. One report from Saudi Arabia also described how they introduced a new “Protected Stroke Mechanical Thrombectomy Code” to enhance safe and timely care for stroke thrombectomy patients; however, there authors did not report any clinical or process data for comparison [ 14 ]. Interestingly, the authors of this report also described prophylactically intubating all stroke patients with LVO on arrival at the emergency department [ 14 ], whereas another proposed algorithm recommended that stroke thrombectomy patients who require general anesthesia should be electively intubated before arrival at the IR suite, whereas those who do not require general anesthesia should proceed to IR suite wearing only a surgical mask [ 15 ].…”

“…One report from Saudi Arabia also described how they introduced a new “Protected Stroke Mechanical Thrombectomy Code” to enhance safe and timely care for stroke thrombectomy patients; however, there authors did not report any clinical or process data for comparison [ 14 ]. Interestingly, the authors of this report also described prophylactically intubating all stroke patients with LVO on arrival at the emergency department [ 14 ], whereas another proposed algorithm recommended that stroke thrombectomy patients who require general anesthesia should be electively intubated before arrival at the IR suite, whereas those who do not require general anesthesia should proceed to IR suite wearing only a surgical mask [ 15 ]. Concurrently, our hospital had substantial personnel changes including redeployment of 5 of our 8 stroke consultants to the medical wards and numerous rehabilitation therapists to the ICU, and many health-care staff became infected or had to be quarantined.…”

Stroke Care Services in Singapore During COVID-19 Pandemic—A National Perspective

“…There have been a few publications with details on how the stroke care has been reorganized due to the COVD-19 situation. Some are hospital-based ( 22 , 23 ) some only address a specific issue e.g., thrombectomy in that hospital ( 24 ). There are no publications on stroke care re-organization at a regional or national level, to my knowledge.…”

Stroke management pathway during COVID-19 pandemic scientific statement by the Saudi Stroke Society

“…Such intervention can be very challenging during the COVID-19 pandemic as proper, safe, and timely delivery of care is needed while on the same time protecting health care workers and other patients is a priority. 6 Recommendations. Thrombolysis with intravenous alteplase should not be delayed when indicated to perform the COVID-19 swab.…”