Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania.
Clinic of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania.
Int J Environ Res Public Health. 2021 Sep 8;18(18):9464. doi: 10.3390/ijerph18189464.
At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic.
A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis.
The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied.
Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients.
在 2019 年冠状病毒病（COVID-19）大流行之初，发现脑血管事件入院人数减少，但急性缺血性中风（AIS）多年来一直是死亡和残疾的主要原因之一。本文旨在回顾当前有关多学科团队（MDT）协调、资源和设施合理管理、确保大血管闭塞（LVO）AIS 患者在疫情期间及时接受血管内治疗的文献数据。
在 Google Scholar 和 PubMed 数据库中使用这些关键字及其组合进行详细的文献检索：急性缺血性中风、急救、麻醉、气道管理、机械血栓切除术、血管内治疗、严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）、COVID-19。筛选了从开始到 2021 年 4 月发表的研究和指南。以下非系统性综述是基于对现有数据的全面文献检索，其中选择了 59 篇进行详细分析。
大流行对 AIS 护理的各个方面都有影响，包括取栓前、手术中和取栓后问题。主要挑战包括机构准备情况、多器官受累的 AIS 患者数量增加、不同的工作协调原则以及对首选麻醉技术的考虑。这些患者的护理由 MDT 主导，并应用非手术室麻醉（NORA）原则。
在大流行期间，对需要机械取栓的 AIS 患者进行适当的管理对于最大限度地提高血管内手术的获益至关重要。MDT 工作和熟悉 NORA 原则可降低疾病对 AIS 患者临床结局的负面影响。
