Protected Code Stroke: Updates from the Frontlines

ABSTRACT

Objective: We recently provided a framework, the protected code stroke, for the implementation of safety measures and other key considerations during the coronavirus disease 2019 (COVID-19) pandemic. Herein we provide updates to the framework from the frontlines as the pandemic evolves. Background: Hyperacute assessment and management of patients with stroke is a time-sensitive and high-stakes clinical scenario. In the context of the current COVID-19 pandemic, the ability to deliver timely and efficacious care must be balanced with the risk of infectious exposure to the clinical team. Furthermore, rapid and effective stroke care remains paramount to achieve maximal functional recovery while rapid triage is important for those who may be presenting with neurological symptoms, but have an alternative diagnosis. Design/Methods: Available resources, COVID-19-specific infection prevention and control recommendations, and expert consensus were used to identify clinical screening criteria for patients and provide the required nuanced considerations for the healthcare team, thereby modifying the conventional code stroke processes to achieve a protected designation. Feedback from frontline providers implementing the protocol was collected. Results: Features specific to pre-notification and clinical status of the patient were used to define pre-code screening. A focused framework was then developed with regard to a protected code stroke. Feedback was used to generate tips with regards to implementation, team management strategies, and an evolving understanding of infection control strategies during a code stroke. Conclusions: We introduce the concept of a protected code stroke during a pandemic, as in the case of COVID-19, and provide a framework for crucial considerations including screening, personal protective equipment, and crisis resource management. These considerations and suggested algorithms can be utilized and adapted for local practice. The protocol has since been endorsed and adopted at many centers globally.