Munson Medical Center, Spectrum Health, North Flight Aero Med launch new protocol
As the “patient” arrived in Munson Medical Center’s Emergency Department with a suspected stroke, a new protocol triggered actions in Grand Rapids and North Flight Aero Med’s dispatch center.
Stroke claims 133,000 lives annually in the U.S. – one person every four minutes.
Munson Medical Center Department of Medicine Chairman Donald Caraccio, M.D., said teams from Munson, Spectrum Health Butterworth Hospital, and North Flight Aero Med practiced their protocol for a type of stroke that occurs when a blood vessel becomes blocked, usually by a blood clot, and a portion of the brain becomes deprived of oxygen. It is called an ischemic stroke.
“We don’t have the capability of offering endovascular treatment for this type of stroke,” he said. “So we have established a regional collaboration with Spectrum Health Butterworth Hospital to transfer those patients who are eligible for this treatment.”
The protocol involves assessing the patient’s brain through a CT scan to determine if a blood vessel to the brain is blocked. If blockage is found, the patient may receive a clot-busting medication called tPA. Meanwhile, members of Munson Medical Center’s stroke team coordinate with Spectrum Health’s stroke team to transfer the patient via North Flight Aero Med’s helicopter for an endovascular procedure to remove the clot.
Spectrum Health neurosurgeon and Vascular Neurosurgery Director Justin Singer, M.D., said the protocol calls for their team to receive the patient in the Emergency Department. On arrival, the patient receives another CT scan – because the tPA may have affected the clot and changed the opportunity to perform procedure.
Sometimes a “perfusion scan” also is ordered to determine if the patient has already experienced a large stroke, which then makes the endovascular procedure less meaningful. If the patient qualifies for the procedure, the patient goes to the neuro-intervention unit and a specially trained physician, such as Dr. Singer, threads a catheter through a groin blood vessel to the site of the clot and removes it.
“From a logistical perspective, it’s not practical for every hospital to have a doctor and the sort of equipment we use to do this procedure,” Dr. Singer said. “We want to work together to provide the best care. Our goal is the patient gets some rehab, and returns home to their family and a high quality of life. We have had several patients who experienced ischemic strokes who have gone on to make a very good recovery.”
Dr. Singer said his unit performed 60 endovascular procedures last year and already has done 40 this year. The time from the stroke to the procedure is critical but the window for care has widened from past years.
“Every hour treatment is delayed brain function decreases by 6 percent,” he said. “It doesn’t have to be a large stroke to have a significant impact if that 6 percent controls movement of the body. We are the closest stroke center by air to Traverse City and that makes us a great partner in that respect.”
Munson’s Stroke Program Medical Director Kersti Bruining, M.D., a neurohospitalist, and Emergency Department Medical Director Tim Archer, M.D., emphasized the importance of offering this evolving specialized stroke treatment option to the region’s patients.
“The stroke team at Munson Medical Center, which involves many types of professionals, has worked hard to help stroke patients in our region. We are very happy that the team has now expanded to include our colleagues at Spectrum Health,” Dr. Bruining said. “We begin the stroke care here at Munson, and our Spectrum Health colleagues continue the care at Spectrum Health, with the goal of offering the highest level of care possible."
Spectrum Health’s Chief of Neurology Tamer Abdelhak, M.D., said the catheter-based treatment can still prove important for patients hours after suffering a stroke. He said Munson Medical Center’s role is crucial.
“Basically in the whole world of stroke care, what we recognize is that stroke is a reversible, treatable, and curable disease,” he said. “However, it’s a time sensitive treatment and cure. The key is to build an air transport bridge to centers, such as Spectrum Health’s to take care of these specific stroke patients. We are dramatically changing the lives of patients in northern Michigan.”
As a certified Primary Stroke Center, Munson Medical Center offers dedicated stroke care led by hospital-based neurologists.
Learn more about Munson Medical Center stroke services.