Ischemic stroke takes place when blood flow to the brain is reduced due to an obstruction in a blood vessel supplying the brain. According to the World Health Organisation, 15 million people suffer a stroke worldwide each year, 5 million are fatal strokes. This makes stroke the second leading cause of death.
This report aims to explore whether the ongoing COVID-19 pandemic has caused delays in receiving possibly life-saving treatment for acute ischemic strokes. The time from arrival at hospital to removal of a blood clot through either thrombolytic medication or surgical thrombectomy is crucial in improving the outcome for the patient. Treatment through thrombolysis involves injecting a patient with a medication to break down a clot in a blood vessel and restore blood flow to the affected area of the brain. In cases where this does not work or poses a high risk of bleeding, thrombectomy is used. Here, the blood clot is removed surgically from within the vessel, restoring normal blood flow. Due to the COVID-19 pandemic, delays to treatment may be seen through increased time for decontamination, changing of personal protective equipment or reduced staff numbers due to social distancing or quarantine.
The authors of this report compared time taken from arrival at hospital to treatment administration in patients admitted pre-COVID-19 (1st March 2019 – 31st July 2019) to those admitted during COVID-19 (1st March 2020 – 31st July 2020). 2955 patients were sampled from 14 US stroke centres, 1491 were admitted pre-COVID-19 and 1464 were admitted during COVID-19.
The standard target is that patients will be treated within 60 minutes of arrival. The report found that patients admitted during COVID-19 had a lower chance of receiving thrombolysis within the 60-minute target window. On average, patients were delayed by 4 minutes. This seemingly insignificant delay could be crucial in achieving a positive outcome for the patient, though data was not collected on the impact this delay had to individual patients. Those 4 minutes could decrease the chances that a patient will make a full recovery without severe functional impairment. The delay was seen between imaging of the brain via CT scan and bolus, or injection of the thrombolytic medication to break down and remove the clot. The use of a CT scan allows doctors to identify the location of the clot and improve the chances that the clot can be removed effectively and safely. The delay in starting treatment is likely due to the time taken to change PPE and decontaminate rooms.
However, in those patients who were treated surgically using a thrombectomy, there was a decrease in treatment time, though not statistically significant. The authors proposed that this was due to an improved waiting time between scan and groin puncture to begin the treatment.
By improving the imaging to treatment time within patients treated with thrombolysis, the impact of COVID-19 on other areas of the healthcare system such as stroke centres may be reduced. This could mean that patients suffering an acute stroke during the COVID-19 pandemic would not experience any delays to their treatment which may damage their chances of a positive outcome.