Code Save -A- Brain

NCH is improving the outcome of stroke.

By Joanna Chau

William Hamlin rushed to the hospital a few days ago with telltale signs of a stroke --- loss of mobility on the right side of his body and speech problems.  

Within three hours of admittance to Naples Community Hospital, doctors assessed him, evaluated him and determined if he needed a life-saving antiblood clotting drug called Tissue plasminogen activator or t-PA.

The speedy protocol is because of NCH’s Code Save-A-Brain program designed to assess stroke and treat patients in a short time frame, improving patient outcomes.

“A brain attack or stroke is an emergency like a heart attack. Time lost is brain lost,” said Robin McCarl-Galbavy, the Director of surgical nursing at NCH. “The longer treatment is delayed the more likely permanent brain damage may occur.”

The program sets in place special protocols. The first assessment happens in the first 10 to 15 minutes in the hospital. A history is obtained and signs and symptoms of a stroke are identified according to a stroke scale. Next, risk factors are identified. Then, the hospital’s team of neurological doctors and nurses are alerted for a Code Save-A-Brain. Blood is tested and a CAT scan is taken. All tests are completed and reported within 45 minutes. This is the standard the hospital is held to as a “hospital of best practice.”

“The process needs to be streamlined and fast in order to get the best possible result,” McCarl-Galbavy said.

From tests and the patient’s assessment, doctors determine if the patient needs t-PA. The drug is the only approved acute stroke treatment for clotrelated or ischemic stroke and has been shown to reduce stroke-related disability. However, it is only approved for use three hours from when symptoms occurred. McCarl-Galbavy said the hospital is currently in the process of extending that to four and a half hours in light of new data.

“This drug has the potential to save lives,” said Helen Einer, a registered nurse and interim nurse manager at NCH’s neuroscience unit. “But it needs to be recognized in time.”

 In 2001 Dr. Jeffrey McCartney and Dr. Robert Tober created the program for NCH making this drug available to the 700-800 stroke patients treated each year. The protocols in the program are modeled after protocols provided by the American Stroke Association.

“We want to make strokes go away with this medicine,” said McCartney, a neurologist and chair of the department of neurology. “But it needs to get to patients as fast as possible. The majority of people who don’t get t-PA are those who don’t get to the hospital soon enough.”

 McCartney said educating the public on the importance of getting to the hospital when stroke symptoms appear goes hand in hand with the program.  

“We try to make the population more aware of what stroke symptoms are,” McCartney said, “and make them aware that we have the program where if they get there in time, they can greatly improve the outcome of a stroke.”

Hamlin is still undergoing testing, but doctors think he had a transient ischemic attack caused by a temporary clot. Symptoms for the “mini stroke” occur rapidly and last a short time. Hamlin is resting, improving and set for rehabilitation soon. Although Hamlin did not need t-PA, he feels he benefited from the program in other ways.

“Part of my healing while I was here was because of the quick treatment,” said Hamlin.

“It gives you a feeling of physical and intellectual safety, and that’s a big part of getting better.”