The Society of NeuroInterventional Surgery (SNIS) has published a set of recommendations for the care of emergent neurointerventional patients during the COVID-19 pandemic.
“Acute ischaemic stroke patients are a high-risk patient cohort,” the authors write, adding that patients with a history of ischaemic stroke and/or its risk factors are “particularly at risk” for the severe form of the coronavirus. The recommendations also acknowledge evidence that the disease can cause neurological signs, which have been reported in the brains of humans and in animal models.
Pointing to a study documenting neurological manifestations of hospitalised patients with COVID-19 in Wuhan, China, the society writes: “36.4% of SARS-CoV-2 [severe-acute respiratory syndrome-coronavirus 2] respiratory distress patients demonstrated neurological symptoms, with 4.5% of severe patients suffering ischaemic stroke.”
Given this evidence, the SNIS recommendations state that in this setting, neurointerventionalists should expect to be involved in the care of COVID-19-positive patients, as well as those whose status is unknown.
The document specifically advises on the criteria for mechanical thrombectomy: “The presence of COVID-19 as a public health issue should not alter the inclusion and exclusion criteria for mechanical thrombectomy […] denial of this treatment likely creates a greater drain on healthcare resources.”
However, the authors urge that maximum safety precautions should be taken when a patient with COVID-19 positive documentation requires treatment. If a patient’s COVID status is unknown, SNIS recommends that patients be treated as high risk for COVID-positive, provided institutional resources are available.
The document also details guidance on post-thrombectomy principals during the pandemic. The society recommends transferring uncomplicated post-thrombectomy patient’s out of the intensive care unit (ICU) “as soon as possible”, to maximise availability of ICU beds. Further, it advocates for COVID-19 testing of all acute ischaemic stroke patients on admission, if available, to allow preservation of personal protective equipment (PPE), and to “separate true COVID-19 positive patients to prevent nosocomial transmission.”
Due to how the cleaning of angiography equipment and suites will impact on the readiness of additional cases, SNIS advises that elective and non-urgent cerebrovascular cases be postponed until the pandemic’s peak has been reduced. Lastly, the society encourages the shift-based allocation of staff and physicians, to separate individuals with overlapping skillsets.
Given the number of identified COVID-19 patients is expected to increase, the authors underline the importance of safe delivery of care for both patients and providers. “If we fail to protect physicians, nursing staff, and ancillary providers, we will fail to meet the needs of future patients.
“The successful care of future COVID-19 patients will depend on the effective safety and prevention strategies for healthcare workers.”
As the COVID-19 pandemic continues to unfold, SNIS will consider revisiting these recommendations to match up-to-date information. Any such revisions will be provided as updates on the SNIS web page, the society advised.