Background and Purpose—Hyperacute assessment and management of patients with stroke, termed code stroke, is a time-sensitive and high-stakes clinical scenario. In the context of the current coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus, the ability to deliver timely and efficacious care must be balanced with the risk of infectious exposure to the clinical team. Furthermore, rapid and effective stroke care remains paramount to achieve maximal functional recovery for those needing admission and to triage care appropriately for those who may be presenting with neurological symptoms but have an alternative diagnosis.Methods—Available resources, COVID-19-specific infection prevention and control recommendations, and expert consensus were used to identify clinical screening criteria for patients and provide the required nuanced considerations for the healthcare team, thereby modifying the conventional code stroke processes to achieve a protected designation.Results—A protected code stroke algorithm was developed. Features specific to prenotification and clinical status of the patient were used to define precode screening. These include primary infectious symptoms, clinical, and examination features. A focused framework was then developed with regard to a protected code stroke. We outline the specifics of personal protective equipment use and considerations thereof including aspects of crisis resource management impacting team role designation and human performance factors during a protected code stroke.Conclusions—We introduce the concept of a protected code stroke during a pandemic, as in the case of COVID-19, and provide a framework for key considerations including screening, personal protective equipment, and crisis resource management. These considerations and suggested algorithms can be utilized and adapted for local practice.

中文翻译：

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受保护的代码中风：2019年冠状病毒病（COVID-19）大流行期间的超急性中风管理。

背景和目的-对卒中患者的超急性评估和管理（称为代码卒中）是一种对时间敏感且高风险的临床方案。在当前由SARS-CoV-2病毒引起的当前2019年冠状病毒疾病（COVID-19）大流行的情况下，必须在及时提供有效护理的能力与传染给临床团队的风险之间取得平衡。此外，对于需要入院的患者而言，快速有效的中风护理仍然至关重要，对于可能出现神经系统症状但又有其他诊断方法的患者，要对其进行适当的分类检查。方法—可用资源，COVID-19特异性感染预防和控制建议，和专家共识可用于确定患者的临床筛查标准，并为医疗团队提供所需的细微考虑，从而修改传统的代码笔触过程以实现受保护的标识。结果—开发了受保护的代码笔触算法。使用特定于患者预告和临床状态的功能来定义预编码筛查。这些包括主要的传染症状，临床和检查特征。然后针对受保护的代码笔划开发了一个重点框架。我们概述了个人防护设备的使用细节及其考虑因素，包括危机资源管理的各个方面在受保护的代码冲程中会影响团队角色的指定和人员绩效因素。结论—我们引入了大流行期间受保护的代码笔划的概念，例如COVID-19，并为包括筛选，个人防护设备和危机资源管理在内的关键考虑因素提供了框架。这些考虑因素和建议的算法可用于本地实践。