It is estimated an individual loses 1.9 million brain cells in the first minute of a stroke, and 10.2 billion brain cells after 10 hours, according to Stephan Mayer, MD, newly appointed Director of Neurocritical Care for the Mount Sinai Health System. “Stroke is really a very devastating disease, but very, very treatable—the key is getting to people quickly,” he says.
On Thursday, April 23, Dr. Mayer convened an Acute Stroke Summit with Carl Ramsay, MD, Vice President, Emergency Medicine Clinical Operations, Mount Sinai Health System, to develop major new protocols in emergency stroke treatment.
It is a rapid and coordinated team approach involving Emergency Medicine, Neurology, Nursing, Neuroradiology, and Pharmacy at each Health System hospital. This approach, when finalized, aims to vastly reshape how each Emergency Department interacts with a stroke patient—a process that will begin with prenotification from the ambulance.
Moving activation of the “Stroke Code” to the ambulance will allow staff to get an early patient history, imaging colleagues to clear CT machines for use, and Pharmacy to order the clot-buster tPA drug. Patients who receive tPA, tissue plasminogen activator, within three to four-and-a-half hours of initial stroke symptoms typically recover more quickly and are less likely to have severe disability.
“It’s all about developing parallel processing, which will allow us to give tPA to more patients, faster,” says Dr. Mayer. “Now, it takes a little over one hour before we can administer tPA. Our eventual goal is 20 minutes.”
He expects the process to be as famously smooth as a NASCAR pit stop. “A typical pit crew involves seven people, and in 12 to 15 seconds, four tires are changed, the car is refueled, and repairs are performed—an effortless process,” he says.
Adds Dr. Ramsay: “This is about instituting every time-saving step that we can to help our patients.”