Impact of the COVID-19-pandemic on thrombectomy services in Germany

Steffen Tiedt, Felix J Bode, Timo Uphaus, Anna Alegiani, Klaus Gröschel, Gabor C Petzold, GSR-ET investigators, Jörg Berrouschot, Tobias Boeckh-Behrens, Georg Bohner, Albrecht Bormann, Michael Braun, Martin Dichgans, Franziska Dorn, Bernd Eckert, Ulrike Ernemann, Jens Fiehler, Christian Gerloff, Gerhard F Hamann, Karl-Heinz Henn, Fee Keil, Lars Kellert, Christoffer Kraemer, Jan Liman, Alexander Ludolph, Christan H Nolte, Martina Petersen, Waltraud Pfeilschifter, Sven Poli, Joachim Röther, Eberhard Siebert, Andreas Siedow, Laszlo Solymosi, Florian Stögbauer, Götz Thomalla, Silke Wunderlich, Sarah Zweynert, Steffen Tiedt, Felix J Bode, Timo Uphaus, Anna Alegiani, Klaus Gröschel, Gabor C Petzold, GSR-ET investigators, Jörg Berrouschot, Tobias Boeckh-Behrens, Georg Bohner, Albrecht Bormann, Michael Braun, Martin Dichgans, Franziska Dorn, Bernd Eckert, Ulrike Ernemann, Jens Fiehler, Christian Gerloff, Gerhard F Hamann, Karl-Heinz Henn, Fee Keil, Lars Kellert, Christoffer Kraemer, Jan Liman, Alexander Ludolph, Christan H Nolte, Martina Petersen, Waltraud Pfeilschifter, Sven Poli, Joachim Röther, Eberhard Siebert, Andreas Siedow, Laszlo Solymosi, Florian Stögbauer, Götz Thomalla, Silke Wunderlich, Sarah Zweynert

Abstract

Background: The Coronavirus Disease 2019 (COVID-19) pandemic may have altered emergency workflows established to optimize the outcome of patients with large-vessel occlusion (LVO) stroke.

Aims: We here analyzed workflow time intervals and functional outcomes of LVO patients treated with endovascular thrombectomy (ET) during the COVID-19 pandemic in Germany.

Methods: We compared the frequency, pre- and intrahospital workflow time intervals, rates of reperfusion, and functional outcome of patients admitted from March 1st to May 31st 2020 with patients admitted during the same time interval in 2019 to 12 university and municipal hospitals across Germany (N = 795).

Results: The number of LVO patients treated with ET between March to May 2020 was similar when compared to the same interval in 2019. Direct-to-center patients and patients admitted through interhospital transfer in 2020 showed similar pre- and intrahospital workflow time intervals compared to patients admitted in 2019, except for a longer door-to-groin time in patients admitted through interhospital transfer in 2020 (47 min vs 38 min, p = 0.005). Rates of reperfusion were not significantly different between 2020 and 2019. Functional outcome at discharge of LVO patients treated in 2020 was not significantly different compared to patients treated in 2019.

Conclusion: Pre- and intrahospital workflows, ET efficacy, and functional outcome of LVO patients treated with ET were not affected during the COVID-19 pandemic in our large cohort from centers across Germany.

Keywords: COVID-19; Large vessel occlusion; Outcome; Stroke; Thrombectomy.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Impact of the COVID-19 pandemic on the number of ET-treated LVO stroke patients in Germany. a The number of patients treated with ET showed no major trend between January 2019 and May 2020. The numbers of patients admitted with ischemic stroke and transient ischemic attack showed a slight reduction during the pandemic months (March to May 2020) when compared with the previous months in 2019 and 2020. b The ratio of patient numbers per center between 2020 and 2019 was not associated with the regional cumulative incidence of COVID-19 (univariable linear regression model). ET, endovascular treatment
Fig. 2
Fig. 2
Impact of the COVID-19 pandemic on pre- and intrahospital workflow time times of LVO patients treated with ET. a Workflow time intervals were similar for direct to center patients between 2020 and 2019 (Mann-Whitney test). b Workflow time intervals were similar for patients undergoing interhospital transfer between 2020 and 2019 except for a longer door-to-groin time in 2020 (Mann-Whitney tets). ET, endovascular treatment; LVO, large vessel occlusion
Fig. 3
Fig. 3
Impact of the COVID-19 pandemic on efficacy measures of ET. a The number of retrieval attempts needed until successful reperfusion was not different between patients with anterior circulation stroke treated in March–May 2020 when compared with the same period in 2019 (Mann-Whitney test). b The rate of successful reperfusion was not different between 2020 and 2019 (Fisher’s exact test). ET, endovascular treatment; mTICI, modified Thrombolysis in Cerebral Infarction
Fig. 4
Fig. 4
Impact of the COVID-19 pandemic on functional outcome after ET. Functional outcome at discharge of patients treated in March–May was not different between 2020 and 2019 in analysis adjusting for potential baseline confounders (multivariable logistic regression analysis). mRS, modified Rankin Scale; ET, endovascular treatment

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Source: PubMed

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