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May 31 2016

From stroke emergency to treatment in 22 minutes

Richard “Rick” Maniaci, 73, of Waukesha, is a walking, talking stroke survivor – which is no small feat in itself. But here’s something else that’s amazing: In the space of just 22 minutes, Maniaci arrived at the hospital, received a CT scan, X-ray, EKG and blood tests, and was treated with medication.

The national goal for treatment of stroke with intravenous medication is 60 minutes from arrival at a hospital to treatment. Maniaci was treated at ProHealth Waukesha Memorial Hospital almost three times faster than that.

After the intravenous administration of tPA, the clot-busting drug tissue plasminogen activator, at Waukesha Memorial, Maniaci was well on his way to countering the stroke-induced visual and cognitive disturbances, mumbling and weakness that he had suddenly experienced late the night before.

“They call me the miracle guy, but the drug, the tPA, that is a miracle,” Maniaci said. “It seems like I never had a stroke. Waukesha Memorial did a heck of a job.”

About 11 p.m. this past Feb. 4, Maniaci was at home, walking to a chair, when he found himself on the floor, unable to feel the right side of his body, and unable to walk or talk. He dragged himself to the chair and tried to use his cell phone to call his wife, Diane, who was asleep upstairs. He was unable to recall his password.

About 90 minutes later, Diane Maniaci awoke and heard a strange rasping sound. Her husband was trying to call out to her. Seeing him, she knew immediately what had happened and called 911 for an ambulance. Her ability to recognize the symptoms of stroke saved precious time in her husband’s care.

City of Waukesha Fire Department EMTs arrived within minutes, knowing what to expect and how to provide emergency care for Maniaci. They also contacted the emergency staff at Waukesha Memorial and provided information about the time that Maniaci was last known to be well and his condition. This communication proved critical as it allowed Maniaci to be transported directly to the Waukesha Memorial imaging department for a CT scan. The emergency team was poised to administer the tPA, and they did so once the scan was reviewed.

“After they put that drug in me, an hour later I started to feel my right leg and then my right arm, but my mind was still scrambled,” Maniaci said.

Throughout the night and following day, ProHealth Care nurses and providers repeatedly asked Maniaci to perform simple language and movement tasks. The Maniacis said they were amazed at how much he progressed hour by hour.

Less than 48 hours after his stroke, Maniaci walked out of the hospital unassisted. Over the next two weeks he performed so well at three outpatient rehabilitation appointments that subsequent appointments were canceled. The only activity he missed was his regular bowling night. He was even out on the golf course early this spring.

“Everyone on the ProHealth team who was involved in Mr. Maniaci’s care was ecstatic for him,” said Veronica Laak, MS, RN, APNP, stroke program coordinator for ProHealth Care. “We know that, in general, the faster tPA is administered, the better the outcome for the patient.”

Stroke is the fifth leading cause of death in the U.S. and the leading cause of serious, long-term disability. Maniaci is among the approximately 500 stroke patients treated at ProHealth Care hospitals each year.

In 2015, 56 percent of stroke patients arrived at ProHeath Care hospitals by ambulance, compared with 46 percent nationwide. The stroke team takes pride in this as it is an indication that ProHealth’s community education efforts about stroke warning signs and symptoms have had an impact on area residents. People are recognizing that stroke is a medical emergency – a brain attack – and are understanding the importance of calling 911.

ProHealth Waukesha Memorial Hospital and ProHealth Oconomowoc Memorial Hospital are both designated as Primary Stroke Centers by the Joint Commission and follow national best practices for stroke care. ProHealth Care has received “Get with the Guidelines” Gold Plus Performance and Quality Achievement Awards from the American Heart Association/American Stroke Association for eight consecutive years at Waukesha Memorial and seven consecutive years at Oconomowoc Memorial. Both hospitals have achieved the associations’ Stroke Honor Roll Elite status for meeting quality measures in reducing the time between a patient’s arrival at the hospital and tPA treatment.

The ProHealth stroke program is nationally recognized for stroke care based on several measures:

  • ProHealth Care has an average length of stay and readmission rates that are lower than the national average.ProHealth Care administers tPA and performs mechanical thrombectomies at a higher rate than other hospitals in Wisconsin and the U.S.
  • ProHealth Care is the first and the only health system in Waukesha County to perform mechanical thrombectomy.
  • Nurses with intensive neuroscience training provide care 24/7 in the ProHealth Care emergency departments, intensive care units, and inpatient neurological and rehabilitation units.
  • ProHealth Care provides extensive rehabilitation services to patients who have experienced strokes, helping them return to the highest level of independence possible. 

The ProHealth stroke team includes specialists from emergency medicine, neurology, neurosurgery, radiology, interventional radiology, neuropsychology, physiatry, physical therapy, occupational therapy, speech therapy and nursing. They work together with the stroke services coordinator to achieve the best possible outcome for each patient.

For more information, please visit ProHealthCare.org/Stroke.

Tissue plasminogen activator (tPA)

tPA drug is considered the gold standard for stroke care. It is the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke, which occurs as a result of an obstruction or clot within a blood vessel supplying blood to the brain. Approximately 70 percent of strokes are diagnosed as ischemic at ProHealth Care hospitals. If given intravenously in the first three hours after the start of stroke symptoms, tPA can significantly reduce the effects of stroke and reduce the chance for permanent disability.

Mechanical thrombectomy

Mechanical thrombectomy may be an option for patients for whom tPA treatment is not recommended or for patients who also receive tPA, depending on the individual. For example, if a stroke patient arrives at the hospital six or seven hours after a stroke event, or if the area of the brain affected is relatively large, physicians may determine that the patient is eligible for a mechanical thrombectomy procedure. In a thrombectomy, a catheter is inserted into the patient’s groin and, with X-ray guidance, the catheter is used to extract the blood clot from the brain and remove it from the body.


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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.