Global impact of COVID-19 pandemic on acute stroke and mechanical thrombectomy-an international survey

Introduction: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on thrombectomy practice Methods: A 19-item questionnaire survey aimed to identify the changes in stroke volumes and treatment practices seen during COVID-19 pandemic was designed using Qualtrics software It was sent to stroke and neuro-interventional physicians around the world who are part of the executive committee of a global coalition, Mission Thrombectomy 2020 (MT2020) between April 5 to May 15 , 2020 Results: There were 113 responses across 25 countries Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during COVID-19 pandemic compared to immediately preceding months (Figure 1A-B) This overall median decrease was despite a median increase in stroke volume in 4 European countries which diverted all stroke patients to only a few selected centers during the pandemic The intubation policy during the pandemic for patients undergoing MT was highly variable across participating centers: 44% preferred intubating all patients, including 25% centers that changed their policy to preferredintubation (PI) vs 27% centers that switched to preferred-conscious-sedation (PCS) There was no significant difference in rate of COVID-19 infection between PI vs PCS (p=0 6) or if intubation policy was changed in either direction (p=1) Low-volume (20 strokes/month) are less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers are more likely to report them to be inadequate (58% vs 92%) Conclusion: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic (Figure Presented)