Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

This document provides guidance on implementing evidence-based stroke care during the COVID-19 pandemic, based on expert opinion from the Canadian Stroke Best Practices Advisory Committee. Despite incomplete and rapidly evolving evidence, we offer early guidance without formal recommendations and evidence grades because urgent changes are necessary. This guidance is based on expert opinion and early shared experiences with reorganizing stroke systems at the time of writing (April 13, 2020). This document is guided by two main principles. First, stroke remains a medical emergency and should be treated as such. Second, stroke care is highly effective. Stroke best practice recommendations remain as evidence-based and relevant as ever, even though logistics and workflows need to change to accommodate the pandemic. Evidence-based stroke care reduces mortality, length of stay, improves functional outcomes and prevents recurrence, contributing to relief of the health system. 8-10 It should not be intentionally stopped or suspended, and this is universally agreed upon by stroke leaders (Appendix 1).