Stroke Rapid-Response Protocol Speeds Up Care, Saves Lives

Friday, May 02, 2008

WABASHA, Minn. — When 80-year-old Philip Brantner, of Pepin, Wis., was treated for a stroke in October 2007 at Saint Elizabeth's Medical Center in Wabasha, Minn., he became the first patient treated with a new stroke rapid-response protocol developed by Mayo Clinic Rochester and used in Mayo Health System and other hospitals in southern Minnesota. This protocol helps maximize a patient's survival and well-being, and helps to minimize brain damage and disability, according to Fred Roberson, M.D., a physician at Wabasha Clinic — part of Lake City Medical Center and Mayo Health System — who treated Brantner in the emergency department.

Brantner's wife, Betty, observed that her husband had symptoms of a possible stroke and immediately called 911 and ultimately increased his chances for a positive outcome. "When Philip's wife said symptoms had begun 45 to 60 minutes earlier, I knew we had a shot at treating Philip with a thrombolytic (clot-busting) medication, using the rapid-response protocol for stroke," says Dr. Roberson. "Getting to activate the protocol and play a role in saving a patient's quality of life was thrilling. We were all very pleased when we learned of Philip's outcome."

The rapid-response protocol for critically ill stroke patients includes: a single-call by the local emergency room physician to a Mayo Clinic care team, including a stroke specialist, to discuss treatment options and alert the Mayo air ambulance transport team; a computed tomography (CT) scan within 10 minutes of arrival at the local emergency room to determine the type of stroke (ischemic or hemorrhagic) and allow treatment to begin; a thrombolytic medication may be injected intravenously to dissolve the clot for patients whose stroke is ischemic and whose symptoms began less than three hours before arrival at the hospital (acute stroke). The thrombolytic medication increases by one-third the chances of a full or almost full recovery.

This Mayo Clinic stroke rapid-response protocol was designed to provide expedited care during regular hours and off-hours on weekdays, weekends and holidays.

"In stroke, time is brain cells — the longer treatment is delayed, the greater the likelihood of brain damage. Timely recognition of symptoms and rapid request for care are crucial for successful treatment," says Alejandro Rabinstein, M.D., a neurologist at Mayo Clinic. "This protocol works because of excellent teamwork between Mayo Clinic and Mayo Health System. Ultimately, this benefits our patients."

After clot-busting medication is administered, patients are quickly transported to Mayo Clinic via air ambulance for further diagnosis, observation and treatment. Mayo Clinic has some of the world's most experienced and skilled specialists in procedures to treat strokes and is one of a few facilities in southern Minnesota that has certified neuroradiology specialists trained to use a specialty device for ischemic stroke treatment — the Mechanical Embolus Removal in Cerebral Ischemia (MERCI). The MERCI device retrieves and removes a clot from an obstructed brain artery, and can be used within the first eight hours of a stroke.

According to Brantner's doctors he has no residual effects from his stroke. "The excellent results in Mr. Brantner's case are due primarily to the quick actions of his wife and by the emergency physician and team at Saint Elizabeth's Medical Center in Wabasha, who immediately recognized symptoms of a stroke and implemented the Mayo stroke protocol without delay," says Dr. Rabinstein. "We hope to hear about many more lifesaving cases like this one."

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