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July 21, 2020; 95 (3) Views & Reviews

Preserving stroke care during the COVID-19 pandemic

Potential issues and solutions

View ORCID ProfileEnrique C. Leira, Andrew N. Russman, José Biller, View ORCID ProfileDevin L. Brown, Cheryl D. Bushnell, Valeria Caso, Angel Chamorro, Claire J. Creutzfeldt, Salvador Cruz-Flores, View ORCID ProfileMitchell S.V. Elkind, Pierre Fayad, Michael T. Froehler, View ORCID ProfileLarry B. Goldstein, Nicole R. Gonzales, Brian Kaskie, Pooja Khatri, Sarah Livesay, David S. Liebeskind, Jennifer J. Majersik, View ORCID ProfileAsma M. Moheet, Jose G. Romano, Nerses Sanossian, Lauren H. Sansing, Brian Silver, Alexis N. Simpkins, Wade Smith, David L. Tirschwell, David Z. Wang, View ORCID ProfileDileep R. Yavagal, View ORCID ProfileBradford B. Worrall
First published May 8, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009713
Enrique C. Leira
From the Departments of Neurology, Neurosurgery & Epidemiology (E.C.L.), University of Iowa, Iowa City, IA; Cerebrovascular Center (A.N.R.), Cleveland Clinic, OH; Department of Neurology (J.B.), Loyola University Chicago, Maywood, IL; Department of Neurology (D.L.B.), University of Michigan, Ann Arbor, MI; Department of Neurology (C.D.B.), Wake Forest School of Medicine, Winston-Salem, NC; Stroke Unit (V.C.), University of Perugia, Italy; Department of Neurology (A.C.), Hospital Clinic, Barcelona, Spain; Department of Neurology (C.J.C., D.L.T.), University of Washington, Seattle, WA; Department of Neurology (S.C.-F.), Texas Tech University, El Paso, TX; Departments of Neurology & Epidemiology (M.S.V.E.), Columbia University, New York, NY; Department of Neurological Sciences (P.F.), University of Nebraska, Omaha, NE; Department of Neurology & Neurosurgery (M.T.F.), Vanderbilt University, Nashville, TN; Department of Neurology (L.B.G.), University of Kentucky, Lexington, KY; Department of Neurology (N.R.G.), McGovern Medical School at UTHealth, Houston, TX; Department of Health Management and Policy (B.K.), University of Iowa, Iowa City, IA; Department of Neurology (P.K.), University of Cincinnati, OH; Department of Adult Health & Gerontology Nursing (S.L.), Rush University, Chicago, IL; Department of Neurology (D.S.L.), UCLA; Department of Neurology (J.J.M.), University of Utah, Salt Lake City, UT; Neurocritical Care, OhioHealth Riverside Methodist Hospital (A.M.M.), Columbus, OH; Department of Neurology (J.G.R.), University of Miami, FL; Department of Neurology (N.S.), University Southern California, Los Angeles, CA; Department of Neurology (L.H.S.), Yale School of Medicine, New Haven, CT; Department of Neurology (B.S.), University of Massachusetts, Worcester, MA; Department of Neurology (A.N.S.), University of Florida, Gainesville, FL; Department of Neurology (W.S.), UCSF; Department of Neurology (D.Z.W.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology & Neurosurgery (D.R.Y.), University of Miami, FL; and Department of Neurology (B.B.W.), University of Virginia, Charlottesville, VA.
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Andrew N. Russman
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José Biller
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Devin L. Brown
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Cheryl D. Bushnell
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Valeria Caso
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Angel Chamorro
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Claire J. Creutzfeldt
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Salvador Cruz-Flores
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Mitchell S.V. Elkind
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Pierre Fayad
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Michael T. Froehler
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Larry B. Goldstein
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Nicole R. Gonzales
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Brian Kaskie
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Pooja Khatri
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Sarah Livesay
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David S. Liebeskind
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Jennifer J. Majersik
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Asma M. Moheet
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Jose G. Romano
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Nerses Sanossian
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Lauren H. Sansing
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Brian Silver
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Alexis N. Simpkins
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Wade Smith
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David L. Tirschwell
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David Z. Wang
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Dileep R. Yavagal
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Bradford B. Worrall
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Full PDF
Citation
Preserving stroke care during the COVID-19 pandemic
Potential issues and solutions
Enrique C. Leira, Andrew N. Russman, José Biller, Devin L. Brown, Cheryl D. Bushnell, Valeria Caso, Angel Chamorro, Claire J. Creutzfeldt, Salvador Cruz-Flores, Mitchell S.V. Elkind, Pierre Fayad, Michael T. Froehler, Larry B. Goldstein, Nicole R. Gonzales, Brian Kaskie, Pooja Khatri, Sarah Livesay, David S. Liebeskind, Jennifer J. Majersik, Asma M. Moheet, Jose G. Romano, Nerses Sanossian, Lauren H. Sansing, Brian Silver, Alexis N. Simpkins, Wade Smith, David L. Tirschwell, David Z. Wang, Dileep R. Yavagal, Bradford B. Worrall
Neurology Jul 2020, 95 (3) 124-133; DOI: 10.1212/WNL.0000000000009713

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Abstract

The coronavirus 2019 (COVID-19) pandemic requires drastic changes in allocation of resources, which can affect the delivery of stroke care, and many providers are seeking guidance. As caregivers, we are guided by 3 distinct principles that will occasionally conflict during the pandemic: (1) we must ensure the best care for those stricken with COVID-19, (2) we must provide excellent care and advocacy for patients with cerebrovascular disease and their families, and (3) we must advocate for the safety of health care personnel managing patients with stroke, with particular attention to those most vulnerable, including trainees. This descriptive review by a diverse group of experts in stroke care aims to provide advice by specifically addressing the potential impact of this pandemic on (1) the quality of the stroke care delivered, (2) ethical considerations in stroke care, (3) safety and logistic issues for providers of patients with stroke, and (4) stroke research. Our recommendations on these issues represent our best opinions given the available information, but are subject to revision as the situation related to the COVID-19 pandemic continues to evolve. We expect that ongoing emergent research will offer additional insights that will provide evidence that could prompt the modification or removal of some of these recommendations.

Glossary

COVID-19=
coronavirus 2019;
GETA=
general endotracheal anesthesia;
ICU=
intensive care unit;
PPE=
personal protective equipment

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • NPub.org/COVID19

  • Received April 8, 2020.
  • Accepted in final form April 29, 2020.
  • © 2020 American Academy of Neurology
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Letters: Rapid online correspondence

  • Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Enrique Leira, MD, MS, University of Iowa
    • Andrew N. Russman, DO, Cleveland Clinic Foundation
    • Bradford B. Worrall, MD, University of Virginia
    Submitted July 28, 2020
  • Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Enrique Leira, MD, MS, University of Iowa
    • Andrew N. Russman, DO, Cleveland Clinic Foundation
    • Bradford B. Worrall, MD, University of Virginia
    Submitted July 24, 2020
  • Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Vaitsa Giannouli, PhD, Institute of Neurobiology, Bulgarian Academy of Sciences
    • Nikolaos Syrmos, PhD, School of Medicine, Aristotle University of Thessaloniki
    Submitted July 23, 2020
  • Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Khichar Shubhakaran, Senior Professor and Head of Department of Neurology, Dr. S.N. Medical College (Jodhpur, India)
    Submitted July 21, 2020
  • Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Enrique Leira, Neurlogist, University of Iowa
    • Andrew N. Russman, DO, Cleveland Clinic Foundation
    • Bradford B. Worrall, MD, University of Virginia
    Submitted June 10, 2020
  • Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Marcele Schettini, Neurologist, Hospital das Clínicas, University of São Paulo, Brazil
    • Adalberto Studart, Neurologist, Hospital das Clínicas, University of São Paulo, Brazil
    • Adriana Bastos Conforto, Neurologist - PhD, Hospital das Clínicas, University of São Paulo, Brazil
    Submitted June 01, 2020
  • Author response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Enrique Leira, MD, MS, University of Iowa
    • Andrew N. Russman, DO, Cleveland Clinic Foundation
    • Mitchell S.V. Elkind, MD, MS, MPhil, Columbia University
    • Bradford B. Worrall, MD, University of Virginia
    Submitted May 19, 2020
  • Reader response: Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions
    • Calixto Machado, Neurologist, AAN Corresponding Fellow, Insttitute of Neurology and Neurosurgery (Havana, Cuba)
    Submitted May 10, 2020
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  • Article
    • Abstract
    • Glossary
    • General principles
    • Acute stroke care delivered during the COVID-19 pandemic
    • Ethical considerations for stroke care during the COVID-19 pandemic
    • Safety and logistic issues for providers of patients with stroke
    • Stroke research during the pandemic
    • Conclusion
    • Study funding
    • Disclosure
    • Appendix Authors
    • Footnotes
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