Why timely action is crucial for saving stroke patients

Representative Image

Rakesh Desai (name changed), 62, a retired banker who lives in the suburbs of Mumbai, started feeling numbness in the face and arm, on one side of the body at 6.00 pm. He was feeling disoriented and had trouble speaking. Desai's wife after dillydallying for an hour called Desai's son Jignesh (named changed). The family decided to wait till Jignesh returned home from the office to take his father to the hospital.

Jignesh who works in South Mumbai took about one and half hour to reach home. Before they got an ambulance and rushed him to the hospital, the four and half hour golden window was over. Doctors, despite their best attempts, could not save Desai.

Time is the essence

If left untreated, stroke loses 1.9 million neurons each minute. Compared with the normal rate of neuron loss in brain ageing, the ischemic brain ages at the rate of 3.6 years each hour without definitive treatment.

For every 15-minute reduction of the door-to-needle time (arrival to the emergency room to thrombolysis), there is a 5 percent lower odds of in-hospital mortality. Each 15-minute decrease in treatment delay can provide an average equivalent of one month of additional disability-free life.

Doctors say if Desai's wife or son had acted immediately and called a 108 ambulance, and rushed him to the nearest hospital with a stroke centre, he could have walked home fine within days.

"If a person is brought to the hospital within the golden hours, upon his arrival at the hospital, he will immediately undergo a brain scan to determine the type of stroke. If it is an ischemic stroke or stroke due to clot, we will immediately start thrombolysis -- a procedure wherein a clot buster or a medication to dissolve the clot and restore blood flow will be given. While this is done, the patient's blood pressure is controlled through medications," Dr Rahul Chakor, Professor at the Department of Neurology, BYL Nair Charitable Hospital, Mumbai, told Moneycontrol.

"If it is a hemorrhagic stroke, we have to do a surgery to repair weak or damaged blood vessel, remove blood from the brain, and reduce pressure in the brain," Chakor said.

Time is of the essence to save patients, Chakor added. Nair Hospital has a state-of-the-art stroke centre.

Rising incidence of stroke

Every 20 seconds, one Indian suffers a stroke. As per ICMR report 2016, stroke is the fourth leading cause of death and the fifth leading cause of disability.

But, a lot of these deaths and disability are preventable by raising awareness, and better preventive and curative stroke services.

Every major public and private hospital needs to have a dedicated 24x7 stroke unit, where stroke patients are attended by a multi-professional team that includes medical, nursing and therapy staff having specialist knowledge, training, and skills in stroke care. Even ambulance services play an important role in saving patients, where time is critical.

"The ambulance services like 108 are geared up for cardiac emergencies, but there is not sufficient focus given to stroke-related emergencies," Dr Shirish Hastak, Regional Director, Neurology, Stroke and Neurocritical Care, Global Hospitals.

The Mumbai Stroke Society had joined hands with Global Hospitals in Parel and the Rotary Club of Bombay in Worli to provide training to doctors and 108 emergency services staff to handle stroke patients in time.

"There are few steps to resuscitate the brain after a stroke and those steps are called ABCD that means A stands for Airway, B for breathing, C for circulation, D for the deficit, duration and drug. ABC is well established but three Ds aren't. It's time to take stroke seriously and nip it in the bud," Dr Hastak said.

"Early intervention is crucial and requires shortening of pre-hospital period. This is possible through education of patients and healthcare professionals and optimization of transport strategies," said Indian Stroke Association, in its recent report that made several recommendations for Acute Stroke Management.

"Availability and access to stroke centers/units with Telestroke expertise will help to treat a larger number of acute stroke patients," ISA said.