New Guidelines for Mechanical Thrombectomy During the COVID-19 Pandemic

May 9, 2020
To keep patients and healthcare providers safe during the coronavirus disease 2019 (COVID-19) pandemic, while providing urgent treatment for patients with stroke, extra precautions must be taken, according to new guidelines published in the journal Stroke. The guidelines were established by the Society of Vascular & Interventional Neurology (SVIN). “People are passing away or having severe strokes out of the hospital,” said David Liebeskind, University of California - Los Angeles Health Sciences (UCLA), Los Angeles, California. “There are a lot of people who are not coming in.” Delaying treatment by just 15 minutes can make a world of difference in terms of a patient’s recovery, yet stroke centres around the country report that they are treating fewer patients than usual. To minimise the possibility of transmitting infections among patients in the hospital, the SVIN team developed guidelines based on review of the published research, consensus among practicing neurologists, and shared best practices. “Some of these things are intuitive or straightforward in terms of minimising exposure and maximising the use of personal protective equipment,” said Dr. Liebeskind. Because patients having a stroke may be unable to communicate and describe their history or symptoms, he said, every patient should be initially considered to be positive for COVID-19. However, according to the guidelines, a definitive diagnosis of COVID-19 should be made as soon as possible, as patients who test negative can decrease the use of protective equipment. Patients who test positive should be placed in isolation in a negative pressure room, when available. Any tests that do not change the treatment strategy should be delayed or deferred until COVID-19 status is established. Telemedicine can play a monumental role in minimising the number of people who come in direct exposure to the patient. For an acute stroke or thrombectomy code, one person in protective equipment can be with the patient, while another coordinates care via computer or phone. Remote tele-stroke technology can also be used to obtain history, perform neurological exams and monitor the patient after the stroke has been treated. “Telemedicine in neurology has evolved over the last 10 years to meet the needs of a consultation,” said Dr. Liebeskind. “In stroke, imaging becomes incredibly important, and that becomes integrated as well. We can do the examination very easily via telemedicine, using a video link at the patient bedside. And, through that same link we can access the imaging information as well. At UCLA, we also have dedicated robots that can travel through the hospital that can do all of this.” A head CT is typically the first test performed in the event of a stroke, and a chest CT can be performed at the same time to check the lungs for COVID-19, if this does not unduly delay stroke treatment. Where possible, conscious sedation can be an alternative to general anesthesia and intubation. This could protect patients from unnecessary intubation and conserves mechanical ventilators. Finally, after thrombectomy or surgery, clinicians should consider relocating patients back to primary stroke centres to recover, especially for hospitals overwhelmed with critical care or intensive care unit bed shortages. Reference: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030100 SOURCE: University of California - Los Angeles Health Sciences