Acute Stroke Care in a New York City Comprehensive Stroke Center during the COVID-19 Pandemic

Background and Purpose The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS) Methods We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020 During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020) Results A total of 754 patients (pandemic-120;pre-pandemic-634) were admitted with a principal diagnosis of AIS;198 (26 3%) received alteplase and/or mechanical thrombectomy Despite longer median door to head CT times (16 vs 12 minutes;p=0 05) and a trend towards longer door to groin puncture times (79 5 vs 71 minutes, p=0 06), the time to alteplase administration (36 vs 35 minutes;p=0 83), door to reperfusion times (103 vs 97 minutes, p=0 18) and defect-free care (95 2% vs 94 7%;p=0 84) were similar in the pandemic and pre-pandemic groups Successful recanalization rates (TICI?2b) were also similar (82 6% vs 86 7%, p=0 48) After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2 90 95% CI 1 77 � 7 17, p?=?0 021) Conclusion Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients