Telestroke Improves Time-Sensitive Care

When it comes to treating strokes, success can truly be measured by the clock. Emergency room physicians and consulting neurologists use the standard of three to 4.5 hours.

That critical window of time begins the moment that stroke symptoms appear and continues as a patient enters the door of the ER.  After that amount of time, it’s likely too risky to administer the clot-busting drug, tPA, which means a greater possibility of permanent disability or death from a stroke.

This time element is a key factor that contributed to the launch last month of the innovative telemedicine program called Telestroke at Baptist Health South Florida.

Through Telestroke, patients with stroke symptoms at West Kendall Baptist Hospital, which already provides primary stroke care, will have immediate 24-hour access to neurologists at Baptist Health Neuroscience Center to enhance response time when needed.

“Instead of sitting in traffic for a half hour or longer, you’re connected in minutes to the patient, nurses and physicians at West Kendall,” said Paul Damski, M.D., a neurologist and Stroke Program Medical Director for Baptist Hospital and West Kendall Baptist Hospital

Stroke kills almost 130,000 Americans each year — that’s one out of every 19 deaths, according to the Centers for Disease Control and Prevention. Every year, more than 795,000 people in the United States have a stroke. And about 610,000 of these are first strokes.

Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases and can potentially be treated with tPA. Far fewer strokes are hemorrhagic, caused when a weakened blood vessel ruptures.

“The time element is so crucial,” said Joseph Scott, M.D., Medical Director, Department of Emergency Medicine, at West Kendall Baptist Hospital. “If there is a clot blocking a vessel in the brain, then we can dissolve that clot if we’re quick enough, potentially allowing the affected area of brain to recover.  The later we wait, the less of a chance there is of reversing damage.”

Telestroke’s Two-Way Live Feed
Telestroke is  much more than a Skype-like call on the neurospecialist’s iPad. The process involves using a two-way, live video and audio hook-up, and a diagnostic image-sharing application. That means a neurologist located miles away can see all diagnostic test results on his or her tablet computer in real time.

Consulting stroke neurologists from the Neuroscience Center can evaluate a West Kendall Baptist Hospital patient to diagnose a stroke and determine the best course of action. The neurologist can speak with the patient and with family members to get vital information, such as the precise time symptoms began to occur.

While tPA can be lifesaving by dissolving a clot in the brain, it may also cause a brain hemorrhage in a small percentage of patients.

“The longer you wait after the symptoms start, the higher the risk of bleeding in the brain after tPA administration,” said Dr. Scott. “Most studies suggest that after four and a half hours, the risk of bleeding from tPA is too great, compared to the potential benefit from dissolving a brain clot.”

ER Goal: 60 Minutes
Both Damski and Scott say that the American Stroke Association recommends that a patient get treated within 60 minutes of walking into the hospital ER. That’s no small feat. The one-hour time frame includes all diagnostics and blood lab work necessary.

“When I’m alerted by West Kendall, I’m on my iPad within seconds on a video conference,” Dr. Damski said. “I can talk and see the patient at the other end. I can also talk with the ER doctor or nurse, and even talk to family members to get a clearer history of what happened.”

Dr. Damski or another member of the Baptist Health Neuroscience Center can guide the clinical staff in administering treatment, which may include the use of tPA, or initiating the transfer to Baptist Hospital if the patient requires advanced therapeutic treatments, such as an interventional neuroradiology procedure or surgery.

Stroke Symptoms
The most effective treatments for stroke must be given within three hours after the onset of symptoms. Therefore, it is vital to recognize the signs of a stroke so that you or someone with you can act quickly and call 9-1-1.  There are a variety of warning signs indicating that  the brain is not getting the blood it needs.

The most widely recognized symptoms of a stroke include:

• Numbness or weakness in the face, arms or legs, particularly on one side of the body.
• Sudden disorientation, confusion or trouble speaking.
• Trouble seeing in one or both eyes.
• Difficulty in walking, lack of  coordination, dizziness or a loss of balance.
• Severe, sudden headache without a known cause.

“With Telestroke, we are bringing the Baptist Health Neuroscience Center to the West Kendall patient’s bedside,” said Dr. Scott. “They receive all the knowledge and expertise that’s about eight miles away. And we avoid that awful traffic.”