Continuing to Advance Stroke Care
Michel Torbey, MDMedical College of Wisconsin Neuro-intensivist;
Medical Director, Stoke Critical Care Program;
Director, Neuro Intensive Care Unit (NICU)
Last year, the Froedtert & Medical College of Wisconsin Stroke and Neurovascular Program achieved certification as a primary stroke center by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). It was the first in the state and the second in the Midwest to be recognized. Michel Torbey, MD, explains what this recognition means and discusses new advances in stroke care.
Q. What is JCAHO primary stroke center certification?Primary stroke center certification is an effort by JCAHO to raise the level of care provided to stroke patients. To receive JCAHO certification, a hospital must meet stringent standards that apply to both acute stroke management and stroke prevention. Our program was surveyed in February 2004, and received notification in April 2004, that it exceeds national criteria and standards. As a certified stroke center, the Froedtert & Medical College of Wisconsin program demonstrated its ability to provide care from a multidisciplinary team of neurologists, emergency medicine specialists, neurosurgeons, radiologists, nurses, therapists, pharmacists, technicians and more, all working in a coordinated, collaborative system.
Q. What advantages does a primary stroke center offer to patients?There are numerous advantages for patients, their families and hospitals. Research from the American Stroke Association shows patients receive a higher quality of care more quickly with fewer complications, spend less time in the hospital and less time in rehabilitation. A primary stroke center has reduced morbidity and mortality, reduced costs, provides a safer environment and results in better patient outcomes.
Effective and safe treatment of stroke requires immediate and expert emergency medical attention, but not all hospitals have the training or expertise to safely administer the latest stroke therapies. At Froedtert & Medical College of Wisconsin, our Acute Stroke Team (FAST) is prepared, providing stroke patients with rapid access to expert diagnosis and treatment, 24 hours a day, 7 days a week. Consisting of critical care neurologists, neurosurgeons, interventional neuroradiologists, emergency medicine physicians and nurse specialists, the FAST team is the only one of its kind in eastern Wisconsin.
Q. Are there any new advances in acute stroke treatment?Currently, the most widely known stroke therapy is intravenous tPA (tissue plasminogen activator). This clot-busting drug can reverse a stroke if given to carefully selected patients within three hours of stroke onset. However, we are now also using arterial tPA – that is, administering it in the artery instead of the vein. This allows us to extend the period of administration from three hours up to six hours. In either situation, tPA can be used to intervene only in certain circumstances since it can be dangerous if inappropriately given. Advanced, very high-quality imaging is helping us determine who would most likely benefit from tPA therapy and allowing us to tailor the therapy to decrease complications.
Advances in imaging are also helping us determine if blood pressure augmentation will benefit patients who do not qualify for tPA or other clot-busting drug therapies. In some patients, raising blood pressure with medication can actually improve their neurological outcome. There have also been advances in the interventional radiology arena, allowing us to go in and catch some of the clots with a snare after a stroke occurs.
Additionally, transcranial Doppler may provide added benefit in the acute stroke setting. This portable ultrasound machine gives us an instantaneous recording of the blood flow to the brain and is used in patient care as a diagnostic device. But recent data indicate that sending the ultrasound beam directly to a clot may help clear the clot and open the blood vessel.
Q. Is research looking at additional acute stroke treatments?There are several clinical trials that are examining new neuro-protective agents, drugs that would protect the brain from injury if administered in a six-hour window following the onset of a stroke. They may either improve results from tPA therapy or be given to patients who do not qualify for tPA.
We are also now in the set-up phase of a clinical trial looking at the use of a hyperbaric oxygen chamber in the acute treatment of stroke. Hyperbaric oxygen is a means of providing additional oxygen to body tissues, and is already used in a variety of medical therapies. However, it has not been used regularly for acute stroke.
Author: Michel Torbey, MD
Source: Every Day
Date: May - August 2005