Abstract
During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.
Highlights
Since the outbreak of COVID-19 in Lombardy, an Italian region with a population of 10 million people
Intravenous Therapy (IVT) with recombinant tissue Plasminogen Activator procedures were performed in the Emergency Department (ED) whilst Endovascular Therapy (EVT) procedures were conducted in the angiographic room
We did not turn down any case requests for the admission of a patient referred to our hospital
Summary
Since the outbreak of COVID-19 in Lombardy, an Italian region with a population of 10 million people. The ability to guarantee treatment for patients presenting with stroke within the time windows dictated by guidelines has become an issue. This is because most of the resources normally available in hospitals had to be devoted to the treatment of COVID-19 patients. The hospital of Varese had to serve as a cerebrovascular hub for the north-western areas of Lombardy, meaning that its referral area was doubled and that the stroke patients could have been taken to Varese either directly by the regional emergency transportation system (Agenzia Regionale dell’Emergenza Urgenza: AREU) or from a spoke hospital located somewhere in Lombardy
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