Alberta stroke treatment now among fastest in world

Quality improvement program cuts time for life-saving drug treatment from 70 to 36 minutes.

The clot-busting drug tPA (tissue Plasmonogen Activator) can be used with ischemic stroke patients to greatly improve their care. John Robertson, CBC Photo

CBC News Edmonton March 6, 2017

Alberta’s stroke treatment centres are now among the fastest in the world in giving patients a clot-busting drug that can save lives, Alberta Health Services said Monday.

The drug is tPA, or tissue Plasminogen Activator.

A year-long quality improvement initiative has seen the average “door-to-needle” time it takes from a patient’s arrival at hospital to being diagnosed with stroke and injected with tPA cut nearly in half, from 70 minutes to 36 minutes.

In a news release Monday, AHS said an improvement of that degree and across such a large geographical area has not been reported anywhere in the world.

A similar effort in the United States saw average door-to-needle times in participating hospitals drop from 74 minutes to 59.

“For many years now, the accepted benchmark has been to treat patients within 60 minutes of their arrival at hospital,” said Dr. Michael Hill, a Calgary-based stroke neurologist.

“But we know that by doing better, we can improve outcomes for patients by preventing or limiting long-term disabilities. And when we can give stroke patients better chances to fully recover, we also eliminate potential downstream costs to the health system.”

Hill is principal investigator in a quality improvement and research program, funded by Alberta Innovates, called QuICR, Quality Improvement & Clinical Research – Alberta Stroke Program.

During an ischemic stroke, in which blood supply to the brain is blocked, about two million brain cells die every minute and about 12 kilometres of neural connections are lost.

Dr Michael Hill, who helped pioneer the development of thrombectomies in Canada, shows pieces of a clot retrieved from a 31-year-old stroke patient. CBC Photo

Edmonton’s Grey Nuns holds record

Noreen Kamal, project manager for QuICR, said improvements have been made in all Alberta stroke centres in the past year — at large hospitals in Edmonton and Calgary but also in smaller centres such as Fort McMurray, Westlock, Red Deer and smaller facilities such as the Grey Nuns Hospital in Edmonton.

The Grey Nuns currently holds the provincial record with the fastest door-to-needle time — six minutes.

“Improvements like this are life-changing for Albertans, and an example of the teamwork and innovative thinking that are helping to strengthen our health system to ensure all Albertans have the care they need when they need it,” said Health Minister Sarah Hoffman.

Dr. Muzaffar Siddiqui, Jean Harsch, Birdie Letendre and Sarah Kayern are medical staff who all work together as a group to speed up stroke patient treatment times. John Robertson, CBC Photo

Patients express gratitude

Two patients at Monday’s news conference talked about their post-stroke lives and their gratitude toward the medical teams who helped them.

Florence Deschamps suffered a stroke in 2016 at her home in Pigeon Lake, Alta.

From her arrival at the Grey Nuns hospital in Edmonton until she was administered the clot-busting drug tPA took 26 minutes.

“I think that it is a miracle that I am alive today,” Deschamps said Monday. “I am still not the way that I used to be, but I am better.”

Melissa Shiach was 33 when she had a stroke.

She was admitted to the Grey Nuns hospital and given tPA as part of her treatment.

“I have my quality of life back but I feel that I got even more back” said Shiach.

“Now when I am doing something as simple with my kids as playing a game of cards or sitting and cuddling and reading a story …I just remember how close I came to losing all of that.”

The signs of stroke

Recognizing the signs of stroke can be the first step to getting correct treatments.

AHS recommends using the mnemonic device FAST.
Face: is it drooping?
Arms: can you raise both?
Speech: is it slurred or jumbled?
Time: to call 9-1-1 right away.

Source CBC News Edmonton