Guidance for Treating Stroke Patients During COVD-19 Crisis Developed

Careful balance of protecting health care workers while treating emergency stroke patients
29-Apr-2020 1:35 PM EDT, by Boston University School of Medicine

Newswise — (Boston)—In an effort to mitigate the spread of COVID-19 and to optimize allocation of healthcare resources, researchers are improving ways to treat patients with acute large vessel occlusion strokes in a safe manner that also better protects health care workers.

Developed by a team from the Society of Vascular & Interventional Neurology (SVIN) and led by a Boston University School of Medicine (BUSM) researcher, the new guidance statement is divided into four phases: pre-hospital to the emergency department, pre-thrombectomy procedure, thrombectomy intra-procedure and post-reperfusion therapy.

“Every opportunity and detail to recalibrate our acute neurological workflow to protect our frontline health care workers, our families, our colleagues and our patients should be sought, implemented and adapted to a resource-constrained environment,” explained corresponding author Thanh Nguyen, MD, professor of neurology, neurosurgery and radiology at BUSM and director of the neuroendovascular service at Boston Medical Center.

Among the recommendations:

  • Screen every acute stroke patient for COVID-19 adhering to local EMS, emergency department (ED) protocols.
  • Use of remote tele-stroke technology to obtain history and perform neurological examination, post reperfusion monitoring, if available.
  • Minimize the number of people at an acute stroke or thrombectomy code: one person in protective equipment with patient, another at computer/phone to help coordinate care.
  • Consider low-dose chest computerized tomography (CT) as the same time as head CT/CTA to facilitate COVID-19 diagnosis.
  • Implement a “direct to the angiography suite” approach for stable transferred patients with stroke symptoms onset within 24 hours to minimize exposure to ED and CT personnel.
  • Consider conscious sedation as first-line to protect anesthesiologists from exposure, and to protect patients from unnecessary intubation as well as conserving mechanical ventilator resources.
  • If patients exhibit pulmonary symptoms, lower threshold to intubate patients in a controlled manner in a negative pressure room.
  • Defer any tests that won’t change management until the patient has ruled out for COVID-19.
  • Consider repatriation of select patients back to primary stroke centers to recover after thrombectomy for hospitals overwhelmed with critical care or intensive care unit bed shortages. This can help maintain thrombectomy access.

According to the researchers, these new workflow applications are based on shared best practices, consensus among academic and non-academic practicing vascular and interventional neurologists and literature review, and could be adapted to the available resources of a local institution.

“The acute stroke patient is a vulnerable group to address because these patients often come emergently from the community with little information. Radical changes are necessary to optimize the safety of the providing team and our patients, limit unnecessary tests, conserve personal protective equipment (PPE) resources and mechanical ventilator usage,” added David Liebeskind, MD, director of the UCLA Comprehensive Stroke Center and SVIN president.

Nguyen believes it is incumbent upon all of us to protect each other so that we are not unknowingly exposed or spread to our most vulnerable patients, while at the same time, providing optimal care, patient safety, and access to treatment for stroke patients. This guidance statement pertains to current practice and can change as new evidence arises.

This guidance statement appears online in the journal Stroke.




Filters close

Showing results

110 of 2457
Newswise: Chaplains Tap Hospital Experience to Guide Faith Communities Through Pandemic
Released: 6-Jul-2020 8:05 AM EDT
Chaplains Tap Hospital Experience to Guide Faith Communities Through Pandemic
Cedars-Sinai

How does a religious congregation, which by definition brings groups of people close together in prayer and communion, navigate this tricky pandemic? Cedars-Sinai chaplains have some of the answers. With expertise as healthcare insiders, they have used their knowledge and experience from their hospital roles to help guide faith communities during this uncharted and unpredictable time.

access_time Embargo lifts in 2 days
Embargo will expire: 6-Jul-2020 11:00 AM EDT Released to reporters: 6-Jul-2020 8:05 AM EDT

A reporter's PressPass is required to access this story until the embargo expires on 6-Jul-2020 11:00 AM EDT The Newswise PressPass gives verified journalists access to embargoed stories. Please log in to complete a presspass application. If you have not yet registered, please Register. When you fill out the registration form, please identify yourself as a reporter in order to advance to the presspass application form.

Newswise: Harmful Microbes Found on Sewer Pipe Walls
Released: 6-Jul-2020 6:00 AM EDT
Harmful Microbes Found on Sewer Pipe Walls
Rutgers University-New Brunswick

Can antibiotic-resistant bacteria escape from sewers into waterways and cause a disease outbreak? A new Rutgers study, published in the journal Environmental Science: Water Research & Technology, examined the microbe-laden “biofilms” that cling to sewer walls, and even built a simulated sewer to study the germs that survive within.

Released: 3-Jul-2020 10:25 AM EDT
Lack of lockdown increased COVID-19 deaths in Sweden
University of Virginia Health System

Sweden’s controversial decision not to lock down during COVID-19 produced more deaths and greater healthcare demand than seen in countries with earlier, more stringent interventions, a new analysis finds.

Released: 2-Jul-2020 3:10 PM EDT
Researchers outline adapted health communications principles for the COVID-19 pandemic
CUNY Graduate School of Public Health and Health Policy

The COVID-19 pandemic has introduced unique challenges for public health practitioners and health communicators that warrant an expansion of existing health communication principles to take into consideration.

Released: 2-Jul-2020 1:40 PM EDT
Collectivism drives efforts to reduce the spread of COVID-19
University of Kent

Research from the University of Kent has found that people who adopt a collectivist mindset are more likely to comply with social distancing and hygiene practices to help reduce the spread of COVID-19.

Released: 2-Jul-2020 12:30 PM EDT
Tiny mineral particles are better vehicles for promising gene therapy
University of Wisconsin-Madison

University of Wisconsin–Madison researchers have developed a safer and more efficient way to deliver a promising new method for treating cancer and liver disorders and for vaccination — including a COVID-19 vaccine from Moderna Therapeutics that has advanced to clinical trials with humans.

Newswise: Newer variant of COVID-19–causing virus dominates global infections
Released: 2-Jul-2020 12:10 PM EDT
Newer variant of COVID-19–causing virus dominates global infections
Los Alamos National Laboratory

Research out today in the journal Cell shows that a specific change in the SARS-CoV-2 coronavirus virus genome, previously associated with increased viral transmission and the spread of COVID-19, is more infectious in cell culture.

Newswise: From Wuhan to San Diego—How a mutation on the novel coronavirus has come to dominate the globe
Released: 2-Jul-2020 12:05 PM EDT
From Wuhan to San Diego—How a mutation on the novel coronavirus has come to dominate the globe
La Jolla Institute for Immunology

Two variants of the novel coronavirus (SARS-CoV-2), called G614 and D614, were circulating in mid-March. A new study shows that the G version of the virus has come to dominate cases around the world. They report that this mutation does not make the virus more deadly, but it does help the virus copy itself, resulting in a higher viral load, or "titer," in patients.

Released: 2-Jul-2020 11:50 AM EDT
New Study Explains Potential Causes for “Happy Hypoxia” Condition in COVID-19 Patients
Loyola Medicine

A new research study provides possible explanations for COVID-19 patients who present with extremely low, otherwise life-threatening levels of oxygen, but no signs of dyspnea (difficulty breathing). This new understanding of the condition, known as silent hypoxemia or “happy hypoxia,” could prevent unnecessary intubation and ventilation in patients during the current and expected second wave of coronavirus.


Showing results

110 of 2457

close
0.82215