Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2023

Open Access 01-12-2023 | COVID-19 | Research

Effect of the COVID-19 pandemic on advanced life support units’ prehospital management of the stroke code in four Spanish regions: an observational study

Authors: Nicolás Riera-López, Francisco Aranda-Aguilar, Montse Gorchs-Molist, Jose Antonio Iglesias-Vázquez

Published in: BMC Emergency Medicine | Issue 1/2023

Login to get access

Abstract

Introduction

Stroke is the most common time-dependent pathology that pre-hospital emergency medical services (EMS) are confronted with. Prioritisation of ambulance dispatch, initial actions and early pre-notification have a major impact on mortality and disability. The COVID-19 pandemic has led to disruptions in the operation of EMS due to the implementation of self-protection measures and increased demand for care. It is crucial to evaluate what has happened to draw the necessary conclusions and propose changes to improve the system’s strength for the future. The study aims to compare prehospital time and neuroprotective care metrics for acute stroke patients during the first wave of COVID-19 and the same periods in the years before and after.

Methods

Analytical, observational, multicentre study conducted in the autonomous communities of Andalusia, Catalonia, Galicia, and Madrid in the pre-COVID-19 (2019), “first wave” of COVID-19 (2020) and post-COVID-19 (2021) periods. Consecutive non-randomized sampling. Descriptive statistical analysis and hypothesis testing to compare the three time periods, with two by two post-hoc comparisons, and multivariate analysis.

Results

A total of 1,709 patients were analysed. During 2020 there was a significant increase in attendance time of 1.8 min compared to 2019, which was not recovered in 2021. The time of symptom onset was recorded in 82.8% of cases, and 83.3% of patients were referred to specialized stroke centres. Neuroprotective measures (airway, blood glucose, temperature, and blood pressure) were performed in 43.6% of patients.

Conclusion

During the first wave of COVID-19, the on-scene times of pre-hospital emergency teams increased while keeping the same levels of neuroprotection measures as in the previous and subsequent years. It shows the resilience of EMS under challenging circumstances such as those experienced during the pandemic.
Literature
1.
Ding Q, Liu S, Yao Y, Liu H, Cai T, Han L. Global, Regional, and National Burden of ischemic stroke, 1990–2019. Neurology. 2022;98(3):e279–90.CrossRefPubMed
2.
Cayuela A, Cayuela L, Ortega Belmonte MJ, Rodríguez-Domínguez S, Escudero-Martínez I, González A. Has stroke mortality stopped declining in Spain? Neurol (English Edition). 2022;37(7):550–6.CrossRef
3.
Kaste M, Norrving B. From the World Stroke Day to the World stroke campaign: one in six: Act now! Int J Stroke. 2010;5(5):342–3.CrossRefPubMed
4.
Mazighi M, Chaudhry SA, Ribo M, Khatri P, Skoloudik D, Mokin M, et al. Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation. 2013;127(19):1980–5.CrossRefPubMed
5.
Jahan R, Saver JL, Schwamm LH, Fonarow GC, Liang L, Matsouaka RA, et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice. JAMA. 2019;322(3):252–63.CrossRefPubMedPubMedCentral
6.
Alabdali A, Yousif S, Alsaleem A, Aldhubayb M, Aljerian N. Can Emergency Medical Services (EMS) shorten the time to Stroke Team activation, computed tomography (CT), and the time to receiving antithrombotic therapy? A prospective cohort study. Prehosp Disaster Med April. 2020;35(2):148–51.CrossRef
7.
Millin MG, Gullett T, Daya MR. EMS Management of Acute Stroke—Out-of-Hospital Treatment andStroke System Development (Resource Document to NAEMSP position Statement). Prehospital Emerg Care 1 Jan. 2007;11(3):318–25.CrossRef
8.
Simal Hernández P, Guiu-Guia JM, Hernández Meléndez T, Aparicio Azcárraga P. Achievements and challenges in stroke care in Spain: from the strategy of the national health system to the european action plan 2018–2030. Rev Esp Salud Publica. 2022 September 23;95:Perspectives21.
9.
Masjuan J, Alvarez-Sabín J, Arenillas J, Calleja S, Castillo J, Dávalos A, et al. [Stroke health care plan (ICTUS II. 2010)]. Neurology. 2011;26(7):383–96.
10.
Kobayashi A, Czlonkowska A, Ford GA, Fonseca AC, Luijckx GJ, Korv J, et al. European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke. Eur J Neurol. 2018;25(3):425–33.CrossRefPubMed
11.
Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, et al. Action Plan for Stroke in Europe 2018–2030. Eur Stroke J. 2018;3(4):309–36.CrossRefPubMedPubMedCentral
12.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with Acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of Acute ischemic stroke: a Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 1 Dec. 2019;50(12):e344–418.
13.
14.
15.
16.
17.
Rudilosso S, Laredo C, Vera V, Vargas M, Renú A, Llull L, et al. Acute stroke care is at risk in the era of COVID-19: experience at a comprehensive stroke center in Barcelona. Stroke Jul. 2020;51(7):1991–5.CrossRef
18.
Montaner J, Barragán-Prieto A, Pérez-Sánchez S, Escudero-Martínez I, Moniche F, Sánchez-Miura JA, et al. Break in the Stroke Chain of Survival due to COVID-19. Stroke. 2020;51(8):2307–14.CrossRefPubMed
19.
Aldujeli A, Hamadeh A, Briedis K, Tecson KM, Rutland J, Krivickas Z, et al. Delays in presentation in patients with Acute Myocardial Infarction during the COVID-19 pandemic. Cardiol Res December. 2020;11(6):386–91.CrossRef
20.
Tejada Meza H, Lambea Gil Á, Sancho Saldaña A, Martínez-Zabaleta M, Garmendia Lopetegui E, López-Cancio Martínez E, et al. Impact of COVID-19 outbreak in reperfusion therapies of acute ischaemic stroke in northwest Spain. Eur J Neurol December. 2020;27(12):2491–8.CrossRef
21.
Khot UN, Reimer AP, Brown A, Hustey FM, Hussain MS, Kapadia SR, et al. Impact of COVID-19 pandemic on critical care transfers for ST-Segment-Elevation myocardial infarction, stroke, and aortic Emergencies. Circ Cardiovasc Qual Outcomes. 2020;13(8):E006938.CrossRefPubMed
22.
Seo AR, Lee WJ, Woo SH, Moon J, Kim D. Pre-hospital delay in patients with acute stroke during the initial phase of the coronavirus disease 2019 outbreak. J Korean Med Sci February. 2022;14(6):e47.CrossRef
23.
García-Basteiro A, Alvarez-Dardet C, Arenas A, Bengoa R, Borrell C, Del Val M, et al. The need for an independent evaluation of the COVID-19 response in Spain. Lancet. 2020;396(10250):529–30.CrossRefPubMedPubMedCentral
24.
25.
Riera-López N, Gaetano-Gil A, Martínez-Gómez J, Rodríguez-Rodil N, Fernández-Félix BM, Rodríguez-Pardo J, et al. The COVID-19 pandemic effect on the prehospital Madrid stroke code metrics and diagnostic accuracy. PLoS ONE. 2022;17(10):E0275831.CrossRefPubMedPubMedCentral
26.
Schwartz J, Dreyer RP, Murugiah K, Ranasinghe I. Contemporary Prehospital Emergency Medical Services Response Times for suspected stroke in the United States. Prehospital Emerg Care. 2016;20(5):560–5.CrossRef
27.
Kim J, Kim C, Park SY. Impact of COVID-19 on Emergency Medical Services for patients with Acute Stroke Presentation in Busan, South Korea. JCM. 2021;11(1):94.CrossRefPubMedPubMedCentral
28.
Huabbangyang T, Klaiangthong R, Prasittichok K, Koikhunthod S, Wanna J, Sudajun N, et al. Comparing Emergency Medical Services Processing Times for Stroke Patients before and during COVID-19 pandemic; a cross-sectional study. Arch Acad Emerg Med. 2022;10(1):e65.PubMedPubMedCentral
29.
Blek N, Szarpak L, Ladny JR. Effect of the COVID-19 pandemic in the Prehospital Management of patients with suspected Acute Stroke: a retrospective cohort study. IJERPH. 2022;19(8):4769.CrossRefPubMedPubMedCentral
30.
Gioia LC, Zewude RT, Kate MP, Liss K, Rowe BH, Buck B, et al. Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics. Neurology. 2016;86(23):2146–53.CrossRefPubMedPubMedCentral
31.
Puolakka T, Väyrynen T, Erkkilä EP, Kuisma M. Fire engine support and On-scene time in Prehospital Stroke care – a prospective observational study. Prehosp Disaster med. 2016 June;31(3):278–81.
32.
Oostema JA, Nasiri M, Chassee T, Reeves MJ. The quality of Prehospital ischemic stroke care: compliance with guidelines and impact on In-hospital stroke response. J Stroke Cerebrovasc Dis. 2014;23(10):2773–9.CrossRefPubMed
33.
Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013;12(6):585–96.CrossRefPubMed
34.
Li T, Cushman JT, Shah MN, Kelly AG, Rich DQ, Jones CMC. Prehospital time intervals and management of ischemic stroke patients. Am J Emerg Med. 2021;42:127–31.CrossRefPubMed
35.
Boulanger J, Lindsay M, Gubitz G, Smith E, Stotts G, Foley N, et al. Canadian stroke best practice recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. Int J Stroke. 2018;13(9):949–84.CrossRefPubMed
Metadata
Title
Effect of the COVID-19 pandemic on advanced life support units’ prehospital management of the stroke code in four Spanish regions: an observational study
Authors
Nicolás Riera-López
Francisco Aranda-Aguilar
Montse Gorchs-Molist
Jose Antonio Iglesias-Vázquez
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2023
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-023-00886-8

Other articles of this Issue 1/2023

BMC Emergency Medicine 1/2023 Go to the issue

Research

Cost-effectiveness of modified diagnostic strategy to safely rule-out pulmonary embolism in the emergency department: a non-inferiority cluster crossover randomized trial (MODIGLIA-NI)

Research

Under the chest pain center mechanism, whether the nursing handover affects the nursing efficiency and the outcomes of patients with STEMI in the emergency department? A retrospective study

Research

Ambulance referral of more than 2 hours could result in a high prevalence of medical-device-related pressure injuries (MDRPIs) with characteristics different from some inpatient settings: a descriptive observational study

Research

Patient factors associated with conveyance decision-making by Emergency Medical Services professionals in patients with a syncope: a cross-sectional factorial survey design

Research

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study

Research

Plasma calprotectin as an indicator of need of transfer to intensive care in patients with suspected sepsis at the emergency department