How NewYork-Presbyterian Is Advancing Crucial Stroke Treatment

A customized ambulance aims to care for patients just minutes after symptoms appear.

Time is of the essence when someone is having a stroke, caused by a blockage or rupture of an artery in the brain. Not only is stroke the leading cause of permanent disability in the United States, it’s also the fifth leading cause of death.

For every minute that passes after blood flow is even partially cut off from the brain, 1.9 million brain cells die because of a lack of oxygen.

If treated within 90 minutes of the onset of symptoms, a stroke victim has a 50 percent chance of making a full recovery. If treatment is delayed three hours, the odds of a full recovery drop to about half that. At four hours, treatment barely has any benefit at all.

The Right Treatment at the Right Moment

Time was on Eliana Correa’s side when she first experienced symptoms of a stroke in January 2017. Between the time Eliana, a world music singer and songwriter, collapsed in the recording studio while rehearsing and the ambulance’s arrival, only 13 minutes had passed.

Technology also was on her side. Eliana was treated in NewYork-Presbyterian’s Mobile Stroke Treatment Unit, an ambulance that is outfitted specifically to treat stroke patients. That allowed Eliana, who says she felt like she was in a state of paralysis at the time, to begin receiving treatment right away; her first dose of a clot-busting thrombolytic drug, or tPA, was administered within an hour of the 911 call.

“She received IV placement, blood work for laboratory studies, a CT scan with radiologist interpretation, and tPA all on board the ambulance,” says Dr. Michael Lerario, medical director of the Mobile Stroke Treatment Unit.

The Mobile Stroke Treatment Unit is part of a broader telehealth initiative at NewYork-Presbyterian, designed to make the hospital’s world-class care more accessible and deliver it faster. Treating strokes is a priority “because stroke is among the most time-sensitive serious illness that we know of. Therefore, rapid diagnosis and treatment in the field is critical,” says Dr. Matthew Fink, neurologist-in-chief and chief of the Division of Stroke and Critical Care Neurology at NewYork-Presbyterian/Weill Cornell Medical Center and the Louis and Gertrude Feil Professor and chairman of the Department of Neurology at Weill Cornell Medicine.

According to the National Stroke Association, someone dies from a stroke every four minutes. And a stroke, which can feel like numbness, weakness, or tingling in an arm or a leg, is often shrugged off until it’s too late. More than half of stroke victims treated at NewYork-Presbyterian don’t call 911 to go to the hospital, preferring instead to use Uber or hail a cab, which minimizes the time in which they can be effectively treated after checking into the hospital, says Dr. Fink.

The medical team aboard the hospital’s unit aims to close that window by administering treatment within the first 60 minutes after symptoms appear and sooner than if patients took their own transportation to the emergency room.

“We refer to that time frame as the golden hour of treatment,” says Dr. Fink. “If we can treat them in under 60 minutes, we’ll have an even higher percentage of people making a complete recovery.”

A Minute-by-Minute Journey

When a call comes in to the New York City 911 system and an operator identifies that someone is likely experiencing a stroke, the operator will deploy the mobile unit if the patient is in the area of coverage. Currently, the unit operates out of NewYork-Presbyterian/Weill Cornell Medical Center on East 68th Street and NewYork-Presbyterian/Columbia University Irving Medical Center on West 168th Street.

The vehicle is staffed by a neurologist, two paramedics, and a computed tomography (CT) technologist. Plans are to have additional units in the future and begin a telestroke program, where a nurse on board would communicate with a neurologist in the hospital, who would examine patients via a two-way audio-visual system.

“Our goal is to have the neurologist sitting in a command center in the hospital, and that person can evaluate multiple patients at the same time,” says Dr. Fink. “Then the neurologist can direct the ambulance teams to give medications as needed.”

The unit is 2 feet longer than a regular New York City ambulance to fit a
CT scanner so the team can take brain scans in the ambulance and then wirelessly send them to the doctors at the hospital.

“We’re using three different wireless network services,” says Dr. Fink. “If one goes down, we’ve got two others in place.” It can take as little as five minutes to take a CT scan in the unit and have a radiologist at the hospital provide a reading of it.

To date, the Mobile Stroke Treatment Unit had been dispatched to 397 calls, transported 72 patients, and administered tPA 27 times. Because it takes 90 days to evaluate a stroke patient’s recuperation, the doctors are still analyzing the Mobile Stroke Treatment Unit’s impact on recovery.

“It’s a little early, but I can just tell you that preliminary results have been great,” says Dr. Fink. “Some of the patients that we treated early on with a thrombolytic drug literally went home from the hospital the next day completely recovered.”

Patients like Eliana have made quick recoveries thanks to their fast treatment.

Because of the fast response of the Mobile Stroke Treatment Unit and the medics’ ability to start all the procedures, medications, and exams in the ambulance, says Eliana, “by the time I got to the hospital I was stabilized already. The ‘damage’ was contained and minimized, and the rehabilitation process could start early.”

After two weeks of rehabilitation at home, she could walk and play music and had her movement back. And the song she was recording on the day of her stroke?

“I have finished the song and since had two live performances,” she says. “I am forever grateful for the crew of the mobile stroke ambulance and the care and treatment I received at NewYork-Presbyterian.”