Mechanical Thrombectomy and Emergency Preparedness Guidance in COVID-19 Era

Authors:
Nguyen TN, Abdalkader M, Jovin TG, et al.
Citation:
Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams: A Guidance Statement From the Society of Vascular and Interventional Neurology. Stroke 2020;Apr 29:[Epub ahead of print].

The following are key points to remember from this guidance statement on mechanical thrombectomy during the COVID-19 pandemic and emergency preparedness for neuroscience teams:

  1. Patients requiring endovascular stroke care present to the hospital emergently, often with little known about their recent medical history. In the COVID-19 era, endovascular stroke care must adapt to the possibility of undiagnosed COVID-19 positivity, as well as to potential shortages in personal protective equipment (PPE) and staffing.
  2. If a patient screens positive for symptoms and signs of COVID-19, all providers should wear PPE for any patient contact. In the emergency department and endovascular suite, team members assessing and treating acute stroke patients should be kept to a minimum to reduce exposure risk and to conserve PPE.
  3. If doing so will not result in a delay of >5 minutes, consider obtaining a chest computed tomography (CT) with CT head and CT angiography head and neck for acute stroke patients with positive pulmonary symptoms.
  4. Because of the risk of undiagnosed COVID-19, conscious sedation should be considered first-line rather than general anesthesia for all stable patients.
  5. Given the risk for pulmonary edema in patients with COVID-19, a negative or even fluid balance should be targeted for each patient.
  6. Post-procedure, there should be a minimum 30-minute delay before cleaning staff enters the angiography suite.
  7. Transfer of a post-thrombectomy patient from a comprehensive stroke center (CSC) to an appropriately resourced primary stroke center (PSC) can be considered if the CSC is experiencing a shortage of ventilators or critical care beds.
  8. Nonintubated and otherwise stable post-thrombectomy patients may be moved to an appropriately resourced step-down unit (e.g., stroke unit) instead of an ICU if there is a current or anticipated shortage of critical care beds.
  9. Post-procedure neurological, vital sign, and access site assessments should be combined and performed by one person, and the frequency should be minimized to conserve PPE. Video can be utilized for monitoring between assessments. A frequency that could be considered includes an assessment: 1) 15-30 minutes after handoff, then 2) every hour for 2 hours, then 3) every 4 hours.
  10. Post-procedure tests that will not change immediate management should be postponed until COVID-19 is ruled out.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Anesthesia, General, Angiography, Coronavirus, COVID-19, Critical Care, Emergency Service, Hospital, Endovascular Procedures, Personal Protective Equipment, Pulmonary Edema, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, Stroke, Thrombectomy, Vascular Diseases, Tomography


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