Brandon is moving to improve stroke care

Manitoba has been behind when it comes to providing quick access to modern stroke care. It is time to catch up. I was in Brandon Wednesday and Thursday evenings to meet with Dr. Michael Hill of Calgary and to hear of Brandon’s plans to move forward on prompt and up to date care for patients who have an acute stroke. Well done Brandon! In the photo I am shown with Dr. Michael Hill and Dr. Charles Norman of Brandon at the meetings.

In Winnipeg we are behind. For at least a decade, scientific and news reports have attested to the near-miraculous effects of using “clot-busting” drugs for treating stroke victims. Where used quickly and appropriately, these drugs can break up the clot causing the stroke, reopen the artery, restore blood to the affected area of the brain and return a person to their former health. A Canadian study, released in May of this year, showed that more than a third (37%) of stroke patients treated with clot-busting drugs had excellent outcomes. The positive outcomes were the same in the 33 high-volume trauma centres and in the 27 community hospitals that were part of the study. Such treatment is now the accepted standard for treating patients with strokes.

Dr. Michael Hill, a researcher and doctor at the University of Calgary Medical School and the study’s co-author, said: “These findings are extremely important because we now have definitive evidence that widespread use of t-PA [clot-busting drugs] for severe stroke will save lives, and help many people return to a completely normal life.”

Yet in Manitoba this approach is only available at St. Boniface Hospital and the Health Sciences Centre. For someone arriving in the emergency room at the Victoria General, Grace, Concordia and Seven Oaks Hospitals in Winnipeg, the modern, standard treatment for stroke is not available. While some will argue that this state of the art treatment for stroke should be standard therapy at all Winnipeg hospitals, at the very least, if modern stroke care is not to be available in some hospitals, then all ambulance and emergency care providers and the general public must know to rush individuals suffering a stroke to a hospital where it is available.

For the best results, the drug must be administered within three hours of the stroke’s symptoms appearing. Indeed, Dr. Michael Hill emphasized at the meeting that the quicker the treatment is provided the better the results. Thus getting treatment within 90 minutes gives significantly better results than at 3 hours. The longer the clot stays and blood flow is blocked, the more brain cells die and are lost, and the damage is no longer readily reversible. Patients must get to the emergency room quickly. Once in the emergency room, an immediate CT scan is required to determine whether the stroke has been caused by a blood clot in the brain (80% of strokes are of this type) or from internal bleeding (20%). This is because the clot-busting drugs are only effective when the stroke is caused by a blood clot. They are contraindicated when there is internal bleeding because they can make the bleeding worse.

In summary, it is time to move to much better treatment for stroke in Manitoba.