Mobile stroke units improve outcomes, treatment times

Patients receiving care at a mobile stroke treatment unit had significantly shorter transfer times to treatment facilities and were more likely to receive thrombolysis within 60 minutes of symptom onset, according to results of two studies presented at the Society for NeuroInterventional Surgery Annual Meeting.

Researchers at Cleveland Clinic conducted a retrospective review of 155 patients treated in the clinic’s mobile stroke treatment unit (MSTU), one of two such units in the United States. It features a portable CT scanner, point-of-care laboratory testing and an onsite treatment team, which allows for rapid diagnosis and treatment administration, as well as real-time communication with offsite stroke specialists, according to the abstract.

Five patients were transferred to centers for intra-arterial therapy after evaluation in the MSTU. Compared with historical controls, these patients had significantly reduced time between unit dispatch and arrival at the center (19 minutes vs. 31 minutes; P = .03), arrival and first CT scan (12 minutes vs. 32 minutes; P = .01), and CT and receipt of intra-arterial therapy (82 minutes vs. 165 minutes; P = .01). Patients first treated at a MSTU also had significantly shorter transfer times to the center compared with those first treated at a primary stroke center (14 minutes vs. 26 minutes; P = .05).

In a second study, researchers evaluated 743 dispatches and 195 patient transports involving the MSTU during its first 32 weeks in operation.

Eight patients had emergent large vessel occlusion strokes and received treatment with IV tissue plasminogen activator (tPA); of those, five were treated within 60 minutes of symptom onset. Among the five patients, one required mechanical thrombectomy and four had spontaneous recanalization. The researchers calculated that the median time from IV tPA to angiogram was 90 minutes. The NIH Stroke Scale improved from a median of 16 at the initial presentation to 1 at discharge.

The researchers concluded that the ability of the MSTU to administer tPA within 60 minutes of symptom onset may improve recanalization rates for emergent large vessel occlusion stroke.

“Determining and facilitating the correct treatment in the shortest amount of time is the most important part of treating stroke, as any delay in treatment can be deadly,” Shazam Hussain, MD, head of the stroke program at Cleveland Clinic, said in a press release. “Time is never on our side, but it’s clear that MSTUs offer the best chance for patients to receive care as fast as possible, sometimes beginning before the patient even arrives at a facility.” – by Adam Taliercio

For more information:

Cerejo R., et al. Presented at: Society of NeuroInterventional Surgery Annual Meeting; July 27-30, 2015; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.