New protocol reduces disabilities, saves lives for stroke patients

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Thursday, May 15, 2014 - 11:04pm

A new partnership is giving stroke victims a better chance at recovery and survival.

Our Lady of the Lake Regional Medical Center and East Baton Rouge EMS have made a small change in their treatment plan that is having a big impact on patient outcomes.

They call the new protocol Stroke Alert. When paramedics pick up an ischemic stroke patient bound for OLOL, they bypass the emergency room and take the patient directly to the stroke center.

"Going through the emergency room can save up to an hour, or even more sometimes. Depends on how busy it is,” noted Mike Chustz, EMS spokesman.

The goal of the protocol is for the patient to undergo a CT scan as quickly as possible to confirm the variety of stroke, and then to receive an injection of a protein called t-PA.

Ischemic strokes are caused by blood clots that prevent oxygen from reaching the brain. t-PA breaks up clots, "and it can save a patient's life, for one," Chustz said. "And it also can decrease any disability that a lot of stroke patients receive."

Stroke is known as one of the easier medical problems to diagnose.

"The typical rapid analysis is called FAST," explained Dr. James Rhorer, Medical Director of Emergency Services at OLOL. "We look at the face; we look at the arms, to test strength; we test their speech; and then we put the T for time, that we're on a time clock to make things happen fast."

The longer a stroke remains untreated, the more brain cells die, making recovery more difficult. But t-PA is only safe to administer for a brief time.

"So if patients arrive after a 3.5 hour period from the onset of their symptoms, it becomes very difficult to consider giving them the clot-buster medication," Rhorer explained.

Ideally, Rhorer noted, patients should receive t-PA within an hour of being admitted to the hospital. But too many stroke victims do not arrive in time to allow that to happen.

"It's 30 percent of the patients who could potentially be eligible to receive the medicine are coming," he stated. "We need that percentage much higher. We need them to get here in time.”

OLOL began looking to improve treatment times in 2011. The average patient waited 46 minutes to get a CT scan and 80 minutes to receive t-PA. By working faster on their own, those times dropped in 2013 to 30 minutes for a CT scan and 71 minutes for t-PA.

"We're now averaging having a CT completed in 14 minutes for the month of March,” Rhorer noted, and 61 minutes for patients to get t-PA.

By administering t-PA quickly, even severe symptoms can be reversed.

"Within 17 minutes, was a most recent case in March, where we had a very successful outcome of a 49-year-old gentleman who had very significant disability with his speech, and unable to move one part of his body," Rhorer mentioned. "And with rapid analysis, and with activating our neurosurgical team within nine minutes of arrival, with administering a t-PA blood clot medication--it's a clot-buster medication--within 50 minutes, this gentleman was able to relieve his symptoms prior to discharge, except for just a little bit of slurred speech that he's getting worked on now.

"That's a measure of success that we would like to offer everybody available in our community."

Our Lady of the Lake is the first local hospital to follow this protocol, but as it gains acceptance around the country, others are likely to follow.

"It's going to have to grow quickly," Rhorer stated.

"I do anticipate this to probably spread throughout all the emergency rooms that receive stroke patients here and there," Chustz said. "I think this is going to be a great thing to have in Baton Rouge, and I think it's going to save some lives, and especially going to prevent further disability caused by strokes.”  

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