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Interventional Neuroradiology during the COVID-19 pandemic

March 30, 2020

Rodrigo Rivera, editor-in-chief of LINNC Online, explains how his hospital is preparing the arrival of the Covid-19 pandemic in Chile and shares a special protocol used in Spain.

With no doubt, we are living an extraordinary moment with this pandemic since the first cases were reported in Wuhan, China, at the end of 2019. The so-called COVID-19 has changed our way of living, moving and working. For sure, several normal workflows of INR departments have changed around the world with this situation, specially the most affected ones in the last weeks such as Italy, Spain, France and now the US East Coast.

In our center in Chile, we have already rescheduled all elective procedures and diagnostic angiographies that could be postponed, preparing the hospital for potential COVID-19 patients, avoiding community spread by non-urgent cases and splitting INR teams for less virus exposition.   

Nevertheless, there are plenty of patients that will still come for INR treatments that can’t be postponed, such as hemorrhagic studies, aneurysmal SAH and especially stroke patients who require immediate revascularization with mechanical thrombectomy.

But how should we proceed inside the Angio-Suite with suspected or confirmed COVID-19 patients?

How to deal with COVID-19 patients in the Angio-Suite?

Mario Martinez-Galdamez from Madrid (Spain) has been working with exposed patients and they have developed a special protocol for COVID-19 patients at his institution. Some of their recommendations are (this could vary between health institutions):

  • In Stroke/urgent patients, additional to brain studies, a chest CT is mandatory in order to search for pulmonary signs of COVID-19 pattern
  • Ask for respiratory symptoms, fever or recent contact with a known COVID-19 (+)
  • All patients should wear a surgical mask from the moment they arrive at the angio-suite and at all times during the procedure if not in general anesthesia.
  • Create working groups (teams) that should not mix and could change in case of exposure/infection of one of the members/team
  • Always use the Personal Protective Equipment (PPE) during the procedure. 
  • Special care for staff that will manipulate patient’s airway (anesthetist and anesthetist nurse). They should always wear N95 masks, face shields or goggles and waterproof gowns.
  • Prepare all drugs and materials before the patient comes inside the room.
  • After the patient is inside, the whole team should stay inside during the procedure from start to end. No in/out circulation.
  • Follow a straight protocol for dressing and take of your PPE.

 

Special protocol for COVID-19 patients

Figure 1. From the INR unit Hospital Clinico Universitario de Valladolid, Spain

 

Exceptional times will require exceptional measures

This situation will last for several months, and we will be exposed as being on the front line against this disease.

Exceptional times will require exceptional care and measures from our community.  Hope every one of you will keep as safe as possible during our daily work!

 

Rodrigo RIVERA MD
Instituto de Neurocirugia Dr. Asenjo, Santiago - Chile.
Editor-in-chief of LINNC Online

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