Guidance on Mechanical Thrombectomy Procedures During COVID-19 Published

The Society for Vascular and Interventional Neurology has released guidelines for safety during mechanical thrombectomy during the COVID-19 pandemic. These guidelines are published in Stroke, the journal of the American Heart Association/American Stroke Association (AHA/ASA). 

The authors of the guideline note in their conclusion that it is incumbent on health care workers to protect themselves and each other during these uncharted times in a resource-constrained environment, while providing optimal care, patient safety, and access to individuals experiencing a stroke. 

Together, these recommendations are designed to protect patients and healthcare workers by limiting the potential spread of virus, conserving personal protective equipment, and addressing any shortages of critical care unit beds.

In brief, recommendations include: 

Before Procedure

• prepare angiography suite with infectious disease precautions
• when possible, place red tape on floor six feet from patient bed and ensure team members keep PPE on in the area within

During Procedure

• keep staff involved in procedure to minimum (1 nurse, 1 technologist, 1 physician)
• keep door to suite closed once patient is in room and post signs to this effect
• consider limiting number of people in control room
• have individuals in control rooms where a mask if angiography suite is a positive pressure room
• reduce risk of pulmonary edema by maintaining negative or even fluid balance for patient 
• draw blood for testing prior to patient leaving angiography suite
• consider cone-beam head CT in angiography suite

Postprocedure

• wait 30 minutes after procedure for perioperative cleaning of the angiography suite 
• postprocedure examination and access site checks should be combined and performed by 1 individual
  •     Use video for continuous monitoring
  •     If video is not available, do another combined check by 1 person at 30 minutes, 90 minutes and then hourly until patient is stable, at which time checks can be every 4 hours
• keep intubated individuals in a negative pressure room
• move noninubated stable patients to a step-down unit if there is a shortage of ICU beds
• test for COVID-19 as soon as possible after thrombectomy to reduce unnecessary use of PPE
• limit imaging studies and other tests to those that will affect patient management
• finish rounds of posttreatment patients with those on contact or droplet precautions
• debrief acute stroke team after procedures to learn and improve best practices and address psychologic effects on the care team 

Before Discharge

• test for COVID-19 before discharge to postacute care facilities
• evaluate patient's mental health before discharge when possible