Intracerebral hemorrhage during the pandemic- Learning from experience

Abstract

Worldwide stroke care was affected by COVID 19 pandemic and the majority of the literature was on ischemic stroke. Intracerebral hemorrhage (ICH) accounts for about one-fourth of strokes worldwide and has got high mortality and morbidity. We aimed to study the effect of the Pandemic on ICH outcomes and flow metrics during the first wave compared to the pre-pandemic period and how that experience was made used in managing ICH during the second wave. Ours was a single-center observational study, where consecutive patients with non-COVID spontaneous ICH aged more than 18 years who presented within 24 hours of last seen normal were included in the study. We selected the months of June, July, and August in 2021 as the second wave of the pandemic, the same months in 2020 as the first wave of the pandemic, and the same months in 2019 as the pre-pandemic period. We compared the 3-month functional outcomes, in hospital mortality and workflow metrics during the three time periods. We found poor three-month functional outcomes and higher hospital mortality during the first wave of the COVID 19 pandemic, which improved during the second wave. In-hospital time metrics measured by the door to CT time which was delayed during the first wave improved to a level better than the pre-pandemic period during the second wave. ICH volume was more during the first and second waves compared to the pre-pandemic period. Other observations of our study were younger age during the second wave and higher baseline systolic BP at admission during both pandemic waves. Our study showed that functional outcomes and flow metrics in ICH care improved during the second wave of the pandemic through crucial re-organization of hospital stroke workflows. We are sharing this experience because we may have to do further rearrangements in future as the upcoming times are challenging due to new variants emerging.