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Co COC, Yu JRT, Macrohon-Valdez MC, Laxamana LC, De Guzman VPE, Berroya-Moreno RMM, Mariano MM, Rivera PPDP, Racpan-Cauntay JLM, Ilano KCS, Trias EC, Domingo AMC, Marcelo AVDB, Pineda-Franks MCC. Acute stroke care algorithm in a private tertiary hospital in the Philippines during the COVID-19 pandemic: A third world country experience. J Stroke Cerebrovasc Dis 2020; 29:105059. [PMID: 32807464 PMCID: PMC7305875 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Since the declaration of the Novel Coronavirus Disease (COVID-19) pandemic, ensuring the safety of our medical team while delivering timely management has been a challenge. Acute stroke patients continue to present to the emergency department and they may not have the usual symptoms of COVID-19 infection. Stroke team response and management must be done within the shortest possible time to minimize worsening of the functional outcome without compromising safety of the medical team. METHODS Infection control recommendations, emergency department protocols and stroke response pathways utilized prior to the COVID 19 pandemic within our institution were evaluated by our stroke team in collaboration with the multidisciplinary healthcare services. Challenges during the COVID-19 scenario were identified, from which a revised acute stroke care algorithm was formulated to adapt to this pandemic. RESULTS We formulated an algorithm that incorporates practices from internationally devised protocols while tailoring certain aspects to suit the available resources in our system locally. We highlighted the significance of the following: team role designation, coordination among different subspecialties and departments, proper use of personal protective equipment and resources, and telemedicine use during this pandemic. CONCLUSIONS This pandemic has shaped the stroke team's approach in the management of acute stroke patients. Our algorithm ensures proper resource management while optimizing acute stroke care during the COVID-19 pandemic in our local setting. This algorithm may be utilized and adapted for local practice and other third world countries who face similar constraints.
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Affiliation(s)
- Christian Oliver C Co
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Ma Cristina Macrohon-Valdez
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Lina C Laxamana
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Vincent Paul E De Guzman
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | | | - Manuel M Mariano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Peter Paul Dela Paz Rivera
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Joana Lyn M Racpan-Cauntay
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Karen Czarina S Ilano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Evita C Trias
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Alyssa Mae C Domingo
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
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Égi C, Horváth J, Hahn K, Kalman B, Betlehem J, Nagy L. Improving Outcomes Achieved by a New Stroke Program in Hungary. Cerebrovasc Dis Extra 2015; 5:132-8. [PMID: 26648970 PMCID: PMC4662292 DOI: 10.1159/000441479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/29/2015] [Indexed: 12/01/2022] Open
Abstract
Background Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm’ program in September 2013 at our medical center. Methods This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013) and after (October 2013-June 2014) the ‘lysis alarm’ program was introduced at our medical center. Results Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle’ time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program). In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm’ program, we have reached a 4% thrombolysis rate at our medical center. Conclusions Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.
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Affiliation(s)
- Csilla Égi
- Markusovszky University Teaching Hospital, University of Pécs, Szombathely, Hungary
| | - Júlia Horváth
- Markusovszky University Teaching Hospital, University of Pécs, Szombathely, Hungary
| | - Katalin Hahn
- Markusovszky University Teaching Hospital, University of Pécs, Szombathely, Hungary
| | - Bernadette Kalman
- Markusovszky University Teaching Hospital, University of Pécs, Szombathely, Hungary
| | - József Betlehem
- Markusovszky University Teaching Hospital, University of Pécs, Szombathely, Hungary
| | - Lajos Nagy
- Markusovszky University Teaching Hospital, University of Pécs, Szombathely, Hungary
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Affiliation(s)
- KM Hassan
- Associate Professor (Medicine) & Neurologist, Command Hospital (SC) Pune 411 040
| | - S Rohatgi
- Professor and Head of Department, Consultant (Medicine & Neurology), Department of Internal Medicine, AFMC, Pune 411 040
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