Acute stroke care during the COVID-19 pandemic. Ictus Madrid Program recommendations

Neurologia (Engl Ed). 2020 May;35(4):258-263. doi: 10.1016/j.nrl.2020.04.008. Epub 2020 Apr 24.
[Article in English, Spanish]

Abstract

Introduction: The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals.

Methods: We conducted a non-systematic literature search using the keywords "stroke" and "COVID-19" or "coronavirus" or "SARS-CoV-2." Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee.

Results: These recommendations address 5 main objectives: 1) coordination of action protocols to ensure access to hospital care for stroke patients; 2) recognition of potentially COVID-19-positive stroke patients; 3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; 4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and 5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home).

Conclusions: The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.

Keywords: COVID-19; Coronavirus; Ictus; SARS-CoV-2; Stroke.

Publication types

  • Practice Guideline
  • Systematic Review

MeSH terms

  • Acute Disease
  • Brain Ischemia / complications
  • Brain Ischemia / diagnosis
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / therapy*
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Community-Acquired Infections / transmission
  • Containment of Biohazards
  • Coronavirus Infections / complications
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / prevention & control
  • Coronavirus Infections / transmission
  • Cross Infection / prevention & control
  • Decision Making, Shared
  • Disease Management
  • Emergency Service, Hospital
  • Health Services Accessibility
  • Health Services Needs and Demand
  • Hospitalization
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional / prevention & control
  • Length of Stay
  • Neuroimaging
  • Pandemics* / prevention & control
  • Patient Transfer
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / prevention & control
  • Pneumonia, Viral / transmission
  • Protective Clothing
  • Spain / epidemiology
  • Telemedicine