Tyler Owens, DO

Montaner J, Barragán-Prieto A, Pérez-Sánchez S, Escudero-Martínez I, Moniche F, Sánchez-Miura JA, Ruiz-Bayo L, González A. Break in the Stroke Chain of Survival due to COVID-19. Stroke. 2020;51:2307–2314.

How has the COVID-19 pandemic affected our modern systems of acute stroke care? Montaner et al. performed a descriptive analysis before and during the current COVID-19 era, giving a glimpse into how the pandemic can negatively affect acute stroke care. The study was done in a southern region of Spain. Key metrics in the study were taken from pre-hospital and hospital acute care.

Data was collected from a region comprised of 2 stroke units and 2 large hospitals. One of the hospitals served as a thrombectomy referral center and the other as a tele-stroke referral center for several community hospitals. Data for the study was collected from an ongoing stroke registry. The study samples included 41 thrombectomies, 32 tele-stroke consults, and 51 patients treated with thrombolysis therapy. The bulk of the analyses focused on data 15 days prior to the outbreak to 15 days after (March 31, 2020).

Several disruptions to the system of acute stroke care were identified. In regards to prehospital care, there was a decrease in stroke hospital dispatches from 78% to 57% (p<0.001), despite there being an overall increase in 911 calls. They also found the mean time of arrival to the hospital from symptom onset had increased by nearly half an hour from 93 minutes to 119 minutes (p<0.001). Notably, there was a decrease in the number of patients who were given thrombolytic therapy and who underwent thrombectomy during the COVID-19 era. The number of thrombolytic treatments decreased from 28 to 23 (p<0.001), and the number of thrombectomies decreased from 24 to 17 (p<0.001). Among other pertinent findings was a decreased number of tele-stroke consults from 25 to 7 (p<0.001).

The authors offered some explanation for the results through indirect or collateral effects of the pandemic. The setbacks in pre-hospital stroke care were considered to be due in part to the 911 or emergency line being down for some time and also possibly related to patients being fearful of coming to the hospital and contracting COVID-19. The delays in hospital arrival were considered to be a reason for relatively fewer patients getting tPA during the pandemic.

Though the study is limited to a small sample size, a single region of a country, and knowing that stroke systems of care vary throughout the world, it provides important insights on how a public health emergency can negatively affect our systems of acute stroke care. It would be interesting to see if other systems of acute stroke care from around the world corroborate the findings from Montaner et al.