The impact of implementing the SNIS recommendations for the care of COVID-19 patients undergoing emergent mechanical thrombectomy

ABSTRACT

Objective: To determine how implementation of Society for Neurointerventional Surgery (SNIS) guidelines affected outcomes for ischemic stroke patients. Background: SNIS issued guidelines for patient management during the coronavirus disease 2019 (COVID-19) pandemic. Recommendations include intubating COVID-19 positive and unknown COVID-19 status patients prior to endovascular thrombectomy, cohorting by COVID-19 status, early discharge, and postponing elective cases. Design/Methods: This was a retrospective cohort study comparing ischemic stroke patients treated with thrombectomy during the COVID-19 pandemic peak (4/1/20-6/30/20) to those treated in 2019 (4/1/19-6/30/19). Statistical tests used for analysis included Kruskal-Wallis, chisquared and Fisher's exact test. Results: There were 112 ischemic stroke patients treated with thrombectomy 55 (49%) in 2019 and 57 (51%) during the COVID-19 peak. There were no differences in thrombectomy among all ischemic stroke admissions in 2019 vs. the COVID-19 peak (22% vs. 24%, p=0.67). COVID- 19 testing was performed in 29 (51%) patients;none were positive. The median age was 68 in 2019 and 69 during the COVID-19 peak, p=0.28;other characteristics were similar. Compared to 2019, a significantly higher proportion of patients were intubated during the COVID-19 peak (96% vs. 45%, p<0.0001). The median days to extubation was 2 days for both groups, p=0.31. The proportion of patients re-intubated was 2% in 2019 vs. 5% during the COVID-19 peak, p=0.95. The median time to groin puncture was significantly shorter in 2019 than during the COVID-19 peak, 38 vs 43 minutes, p=0.002. The TICI score and mRS were similar between groups, p=0.26 and p=0.84, respectively. Conclusions: After implementing SNIS guidelines, including pre-treatment intubation, we observed a statistically significant but not clinically meaningful increased time to groin puncture, which did not negatively impact outcomes. These results suggest hospitals who manage patients efficiently can implement safe management practices in response to COVID-19 without impacting outcomes. We recommend following SNIS guidelines to prevent the spread of COVID-19.