Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

'MANAGEMENT'. 

THIS IS PRECISELY WHY ALL THESE PEOPLE NEED TO BE FIRED.  If you are not even trying to get them cured, GET THE HELL OUT OF THE WAY. This tyranny of low expectations  needs to be excised from stroke.  You have had decades to figure out how to cure people of stroke. Adding COVID-19 should have been a minor addition to that practice.

Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel 

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Adnan I Qureshi, Foad Abd-Allah, Fahmi Alsenani, ...

First Published May 3, 2020 Review Article Find in PubMed

https://doi.org/10.1177/1747493020923234

Article information

Abstract

Background and purpose

On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection.

Methods

The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document.

Results

This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection.

Conclusions

These practice implications with consensus based on the currently available evidence aim to guide clinicians caring (NOT CURING?)for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

Keywords Coronavirus, COVID-19, acute stroke, mechanical thrombectomy, thrombolysis, ischemic stroke

Introduction

The World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) as a pandemic on 11 March 2020. As of 27 April 2020, a total of 3,064,895 patients had been diagnosed globally, with 211,609 deaths. Most patients with confirmed COVID-19 developed fever, cough, and/or dyspnea. Pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), cardiac injury, renal failure, and encephalitis¹ have been reported. Some patients do have Transient Ischemic Attack (TIA) or Stroke as their initial presentation. A comprehensive document providing up-to-date data and guidance to healthcare providers involved in management of acute stroke is needed to meet the new challenges to acute stroke care posed by COVID-19 pandemic.
To develop a comprehensive document, panel members from 18 countries were identified on the basis of their previous work in relevant topic areas. Preference was given to members from countries with large proportion of COVID-19 infected patients and those from countries with previous corona virus infection outbreaks such as Middle East Respiratory Syndrome (MERS) and severe acute respiratory syndrome (SARS). The panel used systematic literature reviews using key words “COVID-19,” AND “corona virus,” OR “stroke,” AND “cerebrovascular disease” from 1 November 2019 to 5 April 5 2020. Additional reference to previously published stroke guidelines, WHO, and Centers for Disease Control and Prevention (CDC) recommendations, relevant non-stroke-related professional guidelines, personal files, and expert opinion were made (see supplemental material for literature reviewed). The report summarized existing evidence, indicated gaps in current knowledge, and when appropriate, formulated practice implications.