Guidance to improve pre-hospital triage, routing of suspected stroke patients amid COVID-19

Guidance to improve pre-hospital triage, routing of suspected stroke patients amid COVID-19

Press releases may be edited for formatting or style | May 14, 2020 Cardiology Stroke
DALLAS, May 13, 2020 — Leading stroke experts from the American Heart Association’s Stroke Council today issued a new framework/guidance, “Pre-hospital Triage of Acute Stroke Patients During the COVID-19 Pandemic,” to establish protocols that optimize handling suspected stroke cases before they arrive at a hospital during the ongoing COVID-19 crisis and future pandemics. The article is published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

The guidance is focused on ensuring appropriate identification, triage and transportation of suspected stroke patients to the nearest appropriate hospital, and increased collaboration between emergency medical services (EMS) and local hospitals to adapt protocols to meet the needs of their communities.

To achieve these goals, the Council recommends:

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increased interactive videoconferencing (telestroke) networks to assess patients;
lowering the threshold for transporting stroke patients directly to hospitals capable of providing mechanical clot-removal treatment; and
considering transporting stroke patients directly to a procedure lab to bypass the emergency room to lessen exposure to infectious disease.
“During the COVID-19 pandemic, it is more important than ever to ensure that stroke patients are taken to the right hospital that can meet their urgent needs at the outset,” said Mayank Goyal, M.D., professor of radiology and clinical neurosciences at the University of Calgary in Alberta, Canada. “We urge patients to call 911 at the first sign of stroke symptoms to ensure quick assessment and access to treatment. Remember to act quickly if you or anyone else has stroke symptoms. The most common symptoms can be remembered with the acronym FAST: Face drooping, Arm weakness, Speech difficulty, then it’s Time to call 911. Symptoms come on suddenly and every minute counts when a stroke is suspected.”

The key messages for health care professionals are:

Timely and enhanced communication between EMS, hospitals and local coordinating authorities are crucial during a pandemic. The current situation also highlights the need for and importance of ambulance-based and facility-based telestroke networks. Given the differences in COVID-19 prevalence, availability of telestroke networks and critical care resources across regions, local triage and transfer protocols will naturally vary.
The main factors to guide the triage decision are a) the likelihood of a large vessel occlusion; b) magnitude of additional delays due to inter-hospital transfer/ workflow efficiency at the primary stroke center (PSC)/Acute Stroke Ready Hospital (ASRH); c) need for advanced critical care resources; and d) available bed/staff/personal protective equipment (PPE) resources at the hospitals.

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