࡚ġġដ ѮᢊသϛॳᏰོବᄇࡨ‫ܒ‬ϛॳࢺแӰᔖńŐŗŊŅĮIJĺ࣫௑፡ᐌϞ࡚ដ

ѮᢊသϛॳᏰོବᄇࡨ‫ܒ‬ϛॳࢺแӰᔖńŐŗŊŅĮIJĺġ
࣫௑፡ᐌϞ࡚ដ
Ԗ᠘‫߈ܭ‬යCOVID-19ࣝ௃ϐቹៜǴᏃᆅ୯ϣҞ߻ӧӚࣚոΚΠǴۘૈஒዴບਢ‫ٯ‬௓‫ڋ‬ϩࢬள
྽Ǵฅઓ࿶ࣽᙴৣϷ‫ځ‬дတύ॥ი໗ྣៈԋ঩ӧ୺Չ࡚‫܄‬ύ॥ࢬำਔǴϝёૈௗ᝻ۚৎᔠࣝϐঁ
ਢǴࣗԿȨคཀ໔ȩௗ᝻COVID-19 ዴບ‫܈‬ᅪ՟ঁਢǴऩӢԜᏤठတύ॥ი໗ྣៈԋ঩ǵࣗԿ୏ે
Ոਵ౽ନ‫ݯ‬ᕍȐEVTȑი໗೿ሡ೏႖ᚆ14ϺǴ߾ஒᝄख़ᡛᅯύ॥‫ݯ‬ᕍϐૈໆǶЀԖࣗ‫ޣ‬ǴऩӢό཈
೷ԋΓ঩‫ޑ‬གࢉǴ೷ԋਭ୻όܰ‫ޑ‬တύ॥‫ݯ‬ᕍ஑཰Γ঩ཞѨǴ๊ߚ୯ΓᆶᙴࣚϐᅽǶӢԶǴঋ៝တ
ύ॥ྣ៝ࠔ፦ᆶᙴᕍΓ঩ϐٛഢᆶӼӄǴჴឦόܰࠅѸ໪҅ຎ٠ቩ཈ೀ္‫ޑ‬᝼ᚒǶ

тόϞү 嗽䎮炻⊭㊔㉥埨ˣသഋЅ૓ഋCT烊(3) 䃉㱽塓

㌺昌COVID-19侭廱ℍ⮰Ⱄ䘬昼暊䕭㇧嗽䎮ᷕ桐
㟡㒂World Stroke Organization (WSO)䵚䪁 㳩䦳炻ᶼ⺢嬘天㚱டߞ೩ॎ‫ޟ‬CTᐠᏢ烊(4) ⛐
ᶲ䘬ȾStroke Care and the COVID19 Pandemicȿ 㱣䗪忶䦳ᷕ炻ᾅ㊩冯慓昊デ㍏䕓ね⮰⭞䘬⭮↯
(https://www.world-stroke.org/news-and-blog/ 倗专烊(5) 憅⮵䔹Ụᾳ㟰炻ӵ൐ᐿ੾‫ܘ‬ϛ໌՗IV
news/stroke-care-and-the-covid19-pandemic)⮰㪬 rt-PAˣ᷎⛐॒ᔆ‫ܖ‬டߞ೩ॎ‫ޟ‬Ֆᆓីኇࡉ忚
ᶳ炻㚱ᶾ䓴⎬⚳儎ᷕ桐䄏嬟⛀昲䘬㈽㚠炻⎗䘤 埴EVT烊(6) 慓嬟Ṣ⒉ᶨ⭂天䨧㇜ᾳṢ旚嬟姕⁁
䎦㬌䕓ね⮵⎬⛘儎ᷕ桐忈ㆸ䘬⼙枧ˤẍ⋿杻䁢 (PPE)烊(7) 憅⮵⎬慓昊ᷳ攻⿍⿏㱣䗪怑ㅱ䕯䘬
ἳ炻朊⮵䔹Ụᾳ㟰㗪㚫⃰ ┱柕䮑㩊炻㬌冱⼰ 姽Ộ炻溻⊝ἧ䓐忂妲姢⮇烉ሉຽᚂᕛ‫ܖ‬Ⴋၗྱ
⎗傥㚫俥婌➟埴≽傰埨㞻䦣昌㱣䗪(EVT)䘬㗪 ོˤ
攻炻⚈侴姙⣂㗪῁⎒㓡ἄ儎悐CT᷎㕥ㇻ朄傰埨 ⛐⽟⚳炻⃀䭉ṾᾹ䡢姢ᾳ㟰ḇ⼰⣂炻Ữ㴟
㞻㹞妋∹(IV rt-PA)烊㬌⢾炻᷎ὅ䄏㍍妠⎚␴䕯 ⽟⟉ᷕ桐ᷕ⽫䘬慓䗪ⷠ夷ṵ傥两临䵕㊩炻⊭㊔
䉨Ἦ 桐晒↮Ⰼ炻ἧ䕭か␴慓䗪⛀昲⛐廱復⍲ ℐ⣑῁䘬EVT㱣䗪炻ᶵ忶ṾᾹ㚱㈲EVT⛀昲↮
㱣䗪㗪傥 ⥍┬䘬旚嬟㍒㕥烊⬠㚫ㆸ⒉ḇ⶚⛐ ㆸၶЍԙষᎈੲ‫ڙ‬炻ẍ性⃵㔜ᾳ⛀昲ᶵ⸠悥⍿
妶婾炻⛐䵲⿍ね㱩ᶳ㩊㞍天ἄ⇘⣂娛䳘ˣ㗗⏎ ⇘䕭㭺⼙枧炻᷎ᶼḇ惵⎰⚳⭞㓧䫾炻㈲⍇㛔儎
㚱‫ۡݲ‬МӇ૖߳៖ᚂᕛღ໥ջӰ૊ᇲ‫ݽ‬ᕛՄ‫ڧ‬ ᷕ桐≈嬟䕭㇧䘬⸲ỵ㷃⋲ẍὃ℞Ṿ慵䕯䕭か暨
‫ڽ‬೰ˣẍ⍲廱復廱昊䘬㓧䫾ˤ⛐㕘≈✉炻䚖⇵ 㯪ˤ⛐伶⚳㚱⣏夷㧉ᾳ㟰Ἦ多䘬ね㱩ᶳ炻ṾᾹ
⣏⣂㔠儎ᷕ桐ᷕ⽫➟埴䘬⿍⿏㱣䗪炷IV rt-PA⍲ ⶚⮎晃怕忯COVID-19䡢姢ᾳ㟰䘤䓇⿍⿏儎ᷕ桐
EVT炸ṵ两临忳ἄ炻Ữ㚫叿慵⛐娊⓷䕭か䘬㍍ 䘬ね㱩炻⛐ᶨ忋ᷚ䘬姽Ộ⼙⁷㩊㞍⍲EVT㱣䗪
妠⎚⍲␤⏠忻䕯䉨烊⍿⇘庫⣏⼙枧䘬⇯Ⱄ⽑‍ ᷕ炻忯⇘䘬⓷柴⊭㊔烉廱復忶䦳ᷕ⚈䁢䭉嶗墯
䕭㇧⍲攨姢䘬忳ἄ炻ẍ⍲姙⣂慓⬠妶婾ㆾ㔁做 暄⎗傥⡆≈㙜曚㗪攻炻䚉⎗傥姕妰䁢COVID-19
暨㓡ㆸጣΰ໌՗ˤ ᾳ㟰⮰Ⱄ䘬CTㆾMRI room炻性⃵⡆≈ᶵ⽭天
⛐㚨㖑䆮䘤ᾳ㟰ˣ嗽䎮ᶲḇ䴻槿庫⣂䘬ᷕ 䘬栗⼙∹㲐⮬炻侴ᶼ屈⡻䘬埨䭉㓅⼙⭌⸦᷶ᶵ
⚳Ἦ婒炻ṾᾹ㚱⇞⭂ᶨ⣿㳩䦳Ἦ嗽䎮⇘⿍姢䘬 ⬀⛐ˤ⃀䭉㰺㚱ᶨᾳprotocol傥⮎晃ㅱẀ㇨㚱ね
儎ᷕ桐ᾳ㟰烉(1) ⃰婧㞍㍍妠⎚ˣ橼㹓⍲␤⏠忻 㱩炻Ữ慵溆㗗天䚉⎗傥ˬኸ៩ശωϽ˭冯ˬၥ
䕯䉨烊(2) ㌺昌COVID-19侭⮯䄏ᶨ凔ᷕ桐㳩䦳 ྛശσϽ˭ˤ

DOI: 10.6318/FJS.202003_2(1).0001

1
 ѮᢊသϛॳᏰོବᄇࡨ‫ܒ‬ϛॳࢺแӰᔖńŐŗŊŅĮIJĺ࣫௑፡ᐌϞ࡚ដ
Ᏸོ࡚ដȈ
ᶨˣ溻⊝⎬慓昊冒埴㒔⭂⚈ㅱCOVID-19䕓ね
ᷳࡨ‫ܒ‬ϛॳprotocol炻⊭㊔stroke code⤪ỽ
┇≽ˣCT⤪ỽ➟埴ˣẍ⍲⼴临ỷ昊⸲ỵ婧
⹎ˤProtocolㅱ䈡⇍叿慵⛐䕭Ṣ↮㳩炻⮯檀
⹎㆟䔹冯ᶵ⣒⎗傥䁢COVID-19ᾳ㟰⽆⿍姢
㩊 崟炻⯙崘ᶵ⎴㳩䦳ˤ
Ḵˣ⃀䭉䚖㧁ṵ㗗⾓忇㱣䗪仢埨⿏ᷕ桐䕭Ṣ炻
Ữ䚖⇵憅⮵COVID-19䡢姢ᾳ㟰㍍⍿⿍⿏ᷕ
桐㱣䗪ᷳ⇑⺲嫱㒂⯂㛒⃭嵛炻ᶼㅱẍᾅ嬟
⎬慓昊ᷳ䤆䴻䥹慓嬟Ṣ⒉冯EVT⛀昲䁢㚨
⣏侫慷炻憅⮵ẍᶳℑ䧖ᶵ⎴桐晒Ⰼ䳂ᷳᾳ
㟰↮徘ᷳˤ
(1) COVID-19ጂຨএਰ炻ㅱ朆ⷠ⮑ヶ姽Ộ
䈡㬲⿍⿏ᷕ桐㱣䗪ᷳ⽭天⿏ˣṢ⒉⬱ℐ
⿏ˣ⁛㝻䕭⁛㑕ᷳ桐晒⿏冯慓䗪傥慷ᷳ
㈧庱傥≃⼴炻⎗侫ㄖ㕤䫎⎰COVID-19
⁛㝻䕭デ㍏㧁㸾ᷳCT⭌ˣ埨䭉㓅⼙⭌
⍲䚠斄旚嬟姕⁁ᶳ忚埴䈡㬲⿍⿏ᷕ桐㱣
䗪ˤ
(2) COVID- 19ᅸխএਰȂ‫ۨܖ‬ড়Ⴄᚔİᔮ
2
࣫‫ޱ‬炻劍䫎⎰䈡㬲⿍⿏ᷕ桐㱣䗪ᷳ怑ㅱ
䕯炻⺢嬘ẍ朄傰埨㞻㹞妋㱣䗪䁢⃰炻⛐
怑䔞旚嬟ˣCOVID-19⁛㝻䕭⁛㑕ᷳ桐
晒⿏⎗㍏冯慓䗪傥慷ᷳ㈧庱傥≃⎗屈㑼
ᶳ炻⎗侫ㄖ忚埴≽傰ℏ埨㞻䦣昌㱣䗪炻
ょㅱ䔞㕤➟埴⇵⮑ヶ㌺昌䃉䕯䉨⁛㝻侭
ᷳ⎗傥⿏ˤ
ᶱˣ溻⊝⎬慓昊㍐⺋ሉຽ೽ଉຨᄆᷳ≇傥炻ᶵ
婾㗗stroke codeᾳ㟰ˣ⿍姢ㆾ䕭㇧ᶨ凔㚫
姢䘮䃞ˤ⎗冯慓昊⎬䥹悐⓮妶⤪ỽἧ䓐ㇳ
怲⎗䓐ᷳ埴≽忂妲䓊⑩炻䓙䤆䴻䥹怈嶅㚫
姢䕭か炻㷃⮹ᶵ⽭天ᷳ㙜曚桐晒ˤ
ẍᶲᶱ溆ℙ嬀炻ᷫὅ䄏䚖⇵⎘䀋䕓ねṵẍ
⠫⢾䦣ℍ䁢ᷣˣ暞㗇䣦⋨ᾳ㟰ᷳね⠫⍣㧉㒔ˤ
Ữ㚱揹㕤䕓ね晐㗪悥⛐嬲⊾炻劍⮯Ἦ㚱⣏夷㧉
䣦⋨デ㝻䘤䓇㗪炻㚫ℵ婧㔜ẍᶲ⎬枭⺢嬘ˤ
⎘䀋儎ᷕ桐⬠㚫⸜庽慓ⷓ䘤⯽⥼⒉㚫
(⎘⣏慓昊昛⽿㖲ˣ㜿⎋攟⹂∱㾇⻀ˣㆸ⣏慓昊
⬳䡏⥵ˣ㕘㦻慓昊嫅捖春)㒔⭂
⎘䀋儎ᷕ桐⬠㚫䦀㚠嗽ˣⷠ⊁䎮ḳˣ䎮ḳ攟⮑⭂
2020⸜5㚰1㖍
 ѮᢊသϛॳᏰོବᄇࡨ‫ܒ‬ϛॳࢺแӰᔖńŐŗŊŅĮIJĺ࣫௑፡ᐌϞ࡚ដ

Taiwan Stroke Society Recommendations for Hyperacute

Stroke Management During the COVID-19 Pandemic
Chih-Hao Chen1, Chi-Hung Liu2, Pi-Shan Sung3, Cheng-Yang Hsieh4, on behalf of
Young Stroke Neurologist Development Committee of Taiwan Stroke Society, approved
by the secretariat, executive directors and chairman of the Taiwan Stroke Society
1
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
2
Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
3
Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
4
Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.

ABSTRACT
During the unprecedented COVID-19 pandemic, balance must be made between the benefit of
efficacious hyperacute stroke management and the risk of infectious exposure of stroke team members.
Based on current clinical experience and experts’ opinions around the world, Taiwan Stroke Society
proposed temporary recommendations for hyperacute stroke management on patients with confirmed or
suspected COVID-19 diagnosis, or patients under home quarantine or isolation status. We also suggest each
hospital to develop protocols or algorithms tailored for local situation. The core concept is to minimize the
risk of exposure and to maximize available medical resources to combat this pandemic while maintaining
proper and ideal stroke management.

Even with the best efforts of many disciplines ŕũŦġŕŢŪŸŢůġŔŵųŰŬŦġŔŰŤŪŦŵźġ

within Taiwan, due to the COVID-19 pandemic,
neurologists and other members of acute stroke
care teams may come into contact with patients
under quarantine, or even become unknowingly
exposed to patients with suspected or confirmed
COVID-19 diagnosis. This may cause members
of the acute stroke care team or the endovascular
thrombectomy (EVT) team to be quarantined for
14 days, severely hampering the care capacity of
stroke patients. In the unfortunate event of a valued
member of our team being diagnosed with or even
passing away because of COVID-19 would be a
grave loss to our medical community and nation.
Therefore, in order to maintain a high standard
of acute stroke care and the safety of our team
members, we must be cautious in our approach of
managing the situation in this difficult time.
ųŦŤŰŮŮŦůťŴĻġ
1. Encourage individual health care institutions
to mandate COVID-19 acute stroke protocols,
including methods and timing of stroke code
initiation, brain CT examination under adequate
protection, and arrangement of hospital beds.
The protocol should specifically emphasize
patient triage, including a separation of patients
with a low risk from those with a high risk of
COVID-19 during ER triage assessment.
2. While our goal should always be the rapid
treatment of acute stroke patients, due to the
prioritization of the protection of our acute
stroke care and EVT team members, we
recommend risk-stratification management of
the following two groups.

3
 ѮᢊသϛॳᏰོବᄇࡨ‫ܒ‬ϛॳࢺแӰᔖńŐŗŊŅĮIJĺ࣫௑፡ᐌϞ࡚ដ
A. For patients with confirmed COVID-19
diagnosis, judicious evaluation must be
paid to weight the benefit and necessity
of acute stroke intervention, the safety of
medical crew members, the risk of infectious
spreading, and the capacity of healthcare
resources. Specialized acute stroke treatment
may be considered while adequate protection
including dedicated CT and angiography
rooms adherent to COVID-19 infection
control guidelines, and sufficient personal
protective equipment are available.
B. For patients with suspected COVID-19
infection, patients under home quarantine
or home isolation, intravenous thrombolytic
therapy (IVT) should be considered as the
first-line treatment. EVT can be considered
if adequate protection can be achieved, the
risk of infectious spreading can be controlled,
and the capacity of healthcare resources can
be guaranteed. However, the possibility of
asymptomatic COVID-19 patients or patients
with mild clinical symptoms should be
carefully evaluated before the procedure.
3. We recommend all health care institutions to
implement telemedicine facilities on acute
stroke code patients and patients who require
neurological consultations, to allow neurologists
to remotely evaluate patients and reduce
unnecessary exposure.
We made the above recommendations with
the understanding that Taiwan has a majority of
confirmed cases being from abroad and has only
sporadic community transmission. However, with
the everchanging nature of the pandemic, should
large-scale community infections occur, the above
recommendations will be adjusted to protect our
valued team members.