Response by Khosravani et al to Letter Regarding Article, “Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic”
2020; Lippincott Williams & Wilkins; Volume: 51; Issue: 8 Linguagem: Inglês
10.1161/strokeaha.120.030243
ISSN1524-4628
AutoresHouman Khosravani, Phavalan Rajendram, Bijoy K. Menon,
Tópico(s)Older Adults Driving Studies
ResumoHomeStrokeVol. 51, No. 8Response by Khosravani et al to Letter Regarding Article, "Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse by Khosravani et al to Letter Regarding Article, "Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic" Houman Khosravani, Phavalan Rajendram and Bijoy K. Menon Houman KhosravaniHouman Khosravani https://orcid.org/0000-0002-4059-9420 Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K., P.R.). , Phavalan RajendramPhavalan Rajendram Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K., P.R.). and Bijoy K. MenonBijoy K. Menon Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine and the Hotchkiss Brain Institute, University of Calgary, Canada (B.J.M.). Originally published18 Jun 2020https://doi.org/10.1161/STROKEAHA.120.030243Stroke. 2020;51:e156–e157Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 18, 2020: Ahead of Print In Response:We thank Barachinni et al for their letter in response to our article in Stroke titled, "Protected Code Stroke: Hyperacute Stroke Management During the Coronavirus Disease 2019 (COVID-19) Pandemic."1 Stroke remains an emergency during the pandemic. We proposed the concept of a protected code stroke, highlighting the importance of vigilant screening, infection prevention and control measures, and a coordinated team response. Having this term named unites teams in a shared cause and mental model during hyperacute resuscitation. We commend Barachinni et al, our Italian colleagues, and indeed all frontline providers across the world who step up each day, face new challenges, and maintain stroke care excellence during these trying times.2,3We agree that the protected code stroke must be combined with hospital/regional-level system change to provide a coordinated response. This pandemic has exposed a potential vulnerability in existing stroke pathways: emergency preparedness and the ability to quickly adapt to emergent crises. One tool as part of mitigation strategies is Crisis Resource Management (CRM), which started in aviation but has spread to several medical specialties including emergency medicine.4 These concepts can in fact scale from the patients to systems of care promoting rapid adaptability to a changing landscape. CRM helps affect change in the behavior of teams that are the core engine of systems of care. Central to CRM are the following core competencies: situational awareness, triage and prioritization, awareness of team cognitive load, role clarity, effective communication, and debriefing. Simulation training is the bedrock of CRM to enhance team performance.In emergency preparedness measures, much like resuscitation, the number of tasks can be overwhelming and often not congruent with resources immediately available to complete them. There can be bias and lack of situational awareness. Prioritization of patients, resources, and nontechnical skills of communication including debriefings are essential. Triage and prioritization strategies must evolve with the pandemic for on-going effective mitigation strategies and avoidance of task saturation. Communication between and within levels of care systems is essential to maintaining high-quality hyperacute stroke care. Frequent and effective debriefing between teams, management, and policymakers brings people together, unify care components, and foster a culture of quality and patient safety.Collectively, the therapeutic tools we have in stroke are only as good as the teams working together to deliver them—central to this are themes embodied by CRM.4,5 The time is now to implement CRM in stroke care.This epoch highlights the need to have systems and protocols in place, at the ready, to be implemented at a rapid pace. Emergency preparedness must be done without compromising core stroke care functions and the integrity of stroke care pathways. Increasingly, this includes leveraging remote technologies to expand the reach/scope of providers. Depending on the nature and height of the pandemic, stroke care resources may need to be re-deployed to support other clinical needs. Similarly, other clinical areas may be called to assist in stroke care. Just-in-time training modules and local/regional emergency protocols developed now will help inform our future strategies.As stroke evolves so must our situational awareness and evaluation of processes that are a value-add and those that may require pruning and refinement moving forward. Our systems of care may forever be altered by this pandemic. CRM and its implementation are uniquely situated on the precipice of our current state—keeping us on the ready now and for future emergencies.DisclosuresNone.FootnotesFor Disclosures, see page e157.References1. Khosravani H, Rajendram P, Notario L, Chapman MG, Menon BK. Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic.Stroke. 2020; 51:1891–1895. doi: 10.1161/STROKEAHA.120.029838LinkGoogle Scholar2. Baracchini C, Pieroni A, Viaro F, Cianci V, Cattelan AM, Tiberio I, Munari M, Causin F. Acute stroke management pathway during Coronavirus-19 pandemic.Neurol Sci. 2020; 41:1003–1005. doi: 10.1007/s10072-020-04375-9CrossrefMedlineGoogle Scholar3. Markus HS, Brainin M. COVID-19 and stroke-a global world stroke organization perspective.Int J Stroke. 2020; 15:361–364. doi: 10.1177/1747493020923472Google Scholar4. Brindley PG, Cardinal P. Optimizing crisis resource management to improve patient safety and team performance: a handbook for all acute care health professionals. Ottawa, Canada: Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/ppi/educational-resources-e. Accessed May 26, 2020.Google Scholar5. Reid C, Brindley P, Hicks C, Carley S, Richmond C, Lauria M, Weingart S. Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness.Clin Exp Emerg Med. 2018; 5:139–143. doi: 10.15441/ceem.17.269Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By de Oliveira L, Ponciano A, Kashani N, Guarda S, Hill M, Smith E, Stang J, Viswanathan A, Turner A and Ganesh A (2023) Stroke metrics during the first year of the COVID-19 pandemic, a tale of two comprehensive stroke centers, Scientific Reports, 10.1038/s41598-023-44277-2, 13:1 Chen R, Wang K, Yu J, Howard D, French L, Chen Z, Wen C and Xu Z (2021) The Spatial and Cell-Type Distribution of SARS-CoV-2 Receptor ACE2 in the Human and Mouse Brains, Frontiers in Neurology, 10.3389/fneur.2020.573095, 11 Bohórquez Rivero J, Sáenz López J, Tatis Villamizar K and Guzmán Sáenz R (2021) Aspectos fisiopatológicos y manifestaciones neurológicas asociadas a la infección por SARSCoV-2/COVID-19., Revista Ciencias Biomédicas, 10.32997/rcb-2021-3235, 10:1, (39-54) Paliwal P, Tan B, Leow A, Sibi S, Chor D, Chin A, Yau Y, Cross G, Wong L, Chia M, Quak Z, Chua C, Tang D, Zune E, Hung J, Goh Y, Jing M, Gopinathan A, Yang C, Ahmad A, Khoo D, Lee C, Seet R, Sharma V, Teoh H, Yeo L and Chan B (2020) Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore, Journal of Thrombosis and Thrombolysis, 10.1007/s11239-020-02225-1, 50:3, (596-603), Online publication date: 1-Oct-2020. Al-Jehani H, John S, Hussain S, Al Hashmi A, Alhamid M, Amr D, Ozdemir A, Shuaib A, Alhazzani A, Ghorbani M, Mansour O and Saqqur M (2020) MENA-SINO Consensus Statement on Implementing Care Pathways for Acute Neurovascular Emergencies During the COVID-19 Pandemic, Frontiers in Neurology, 10.3389/fneur.2020.00928, 11 Venketasubramanian N (2020) Stroke Care Services in Singapore During COVID-19 Pandemic—A National Perspective, Frontiers in Neurology, 10.3389/fneur.2020.00780, 11 Goyal M, Ospel J, Southerland A, Wira C, Amin-Hanjani S, Fraser J and Panagos P (2020) Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic, Stroke, 51:7, (2263-2267), Online publication date: 1-Jul-2020. Smith E, Mountain A, Hill M, Wein T, Blacquiere D, Casaubon L, Linkewich E, Foley N, Gubitz G, Simard A and Lindsay M (2020) Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 10.1017/cjn.2020.74, 47:4, (474-478), Online publication date: 1-Jul-2020. ŞİMŞEKOĞLU R and TOMBUL T (2020) Covid-19 Pandemic and Neurological ManifestationsCovid-19 Pandemisi ve Nörolojik Tutulumlar, Anadolu Kliniği Tıp Bilimleri Dergisi, 10.21673/anadoluklin.738020, 25:Special Issue on COVID 19, (246-251) August 2020Vol 51, Issue 8 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.120.030243PMID: 32716831 Originally publishedJune 18, 2020 PDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac CareQuality and Outcomes
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