Brain COVID-19 (coronavirus)

Stroke recommendations developed at Sunnybrook adopted internationally

Protected Code Stroke team poses for a photo beside an imaging device
Written by Jennifer Palisoc

Hospital emergency codes are used to alert staff quickly to a medical emergency. When a “code stroke” is called, stroke neurology team members and teams from other services such as the emergency department, diagnostic imaging, anesthesia, and neurovascular surgery come together to treat a potential stroke patient’s most immediate symptoms.

In March 2020, during the early days of the COVID-19 pandemic, Sunnybrook’s stroke team worked quickly to implement changes to “code stroke”. It is now known as “protected code stroke,” which is designed to enhance the safety of both patients and frontline health-care workers.

These recommendations have since been adopted around the world and incorporated into the Canadian Stroke Best Practice Guidelines, American Heart Association, World Stroke Organization and stroke guidelines in India and Japan.

“Protected code stroke was developed by Sunnybrook’s stroke team, which collaborated with colleagues in the emergency department, critical care, as well as a colleague in Calgary” says Dr. Houman Khosravani, medical director of the inpatient stroke unit in the Hurvitz Brain Sciences Program. “This incredible collaboration allowed us to work quickly to outline key steps at a critical point in the pandemic.”

Sunnybrook is one of nine regional stroke centres in Ontario.

Protected Code Stroke

“Key considerations of this new protocol include enhanced pre-screening for infection control, personal protective equipment or PPE for staff and patients, and designation of a safety leader to monitor the team’s overall safety,” says Dr. Khosravani. “Among other measures, we also modified how we communicate during a protected code stroke to be clearer and more concise, which enhances efficiency.”

During the early stages of the pandemic, the team published a paper, Hyperacute Stroke Management During the Coronavirus Disease 2019 Pandemic, in the journal Stroke.

“This dialogue between Sunnybrook and international partners in stroke was important, especially at the beginning of the pandemic when health-care teams around the world were just learning about the COVID-19 virus,” says Dr. Khosravani. “We are honoured to have contributed to the international community with the protected code stroke recommendations to help enhance safety for patients and health-care teams during a stroke emergency.”

Since being published, the paper has been downloaded approximately 10,000 times from the journal’s website with the terminology and process being used in hospitals worldwide. It has been cited over 200 times in other journals.

Get help in a stroke emergency

Dr. Houman Khosravani

Dr. Houman Khosravani

“The stroke team and other medical teams have been safely caring for patients throughout the pandemic. We have become even more proficient in screening, running codes, and working together,” adds Dr. Khosravani.

“The enhanced interprofessional team collaboration and safety measures are a silver lining of COVID-19, and for our patients, it’s important to know that all of these efforts mean the hospital remains a safe place to go to for all medical emergencies.”

If further therapy for stroke is needed, experts from internal medicine, critical care medicine, and the neurovascular unit are also part of the patient’s care journey.

The signs of a stroke can be remembered using the acronym FAST, which stands for:

Face: Is the face drooping?
Arms: Can you raise both arms?
Speech: Is speech slurred or jumbled?
Time to call 9-1-1

Dr. Khosravani says it is critical to act quickly if an individual is showing signs of a stroke.

“In a stroke emergency, time is brain,” says Dr. Khosravani. “Every minute counts and the faster a stroke patient is treated, the less damage there may be to the brain. Seek medical attention as quickly as you can if you see or experience signs of stroke.”

Learn about the signs of stroke and how to act FAST »

Read about Your Stroke Care Pathway »

About the author

Jennifer Palisoc

Jennifer Palisoc is a Communications Advisor at Sunnybrook.

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