What are the guidelines for evaluating and managing stroke in patients with coronavirus disease 2019 (COVID-19)?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Because patients with COVID-19 infection have high risk of developing acute stroke, an international panel of stroke experts from 18 countries issued a set of recommendations for managing acute ischemic stroke patients with either suspected or confirmed infection with the virus. [147, 148] Their recommendations include the following:

  • Due to the high rate of mortality in COVID-19 patients who have multiple organ dysfunctions/failure, a Sequential Organ Failure Assessment (SOFA) score may be helpful in devising a treatment plan.

  • It is reasonable to perform chest CT and/or radiography to identify radiologic abnormalities suggestive of COVID-19 infection.

  • It is important to take into account risk factors for contrast-induced nephropathy due to the high rate of renal insufficiency in patients with COVID-19.

  • Tests for assessing coagulation profile such as thromboelastography and serum concentration of D-dimers may be considered as needed.

  • A stringent policy is required to select acute ischemic stroke patients for mechanical thrombectomy.

  • If intubation is needed, the procedure should be performed in a negative-pressure room with teams of experienced clinicians wearing protective gear and using video-guided laryngoscopy. A tracheobronchial specimen may be taken at this time to confirm suspected COVID-19 infection.

  • Parameters from the SIESTA trial [149] should be used if intubation and mechanical ventilation are performed to ascertain that there is no decrease in blood pressure or abnormal blood gases during the procedure.


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