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Mobile stroke units 30 minutes faster than conventional ambulance
Mobile stroke units operating in the densely populated area of Manhattan, New York, can reduce the dispatch-to-thrombolysis time by 30 minutes compared with patients transported via conventional ambulance, and patients have a shorter average ride.
According to the findings published in the Journal of the American Heart Association, mobile stroke units operating in Manhattan had a shorter dispatch-to-thrombolysis time compared with conventional ambulance (mean, 61.2 vs. 92.6 minutes; P = .001).
Moreover, patients experiencing ischemic stroke were more likely to be picked up closer to a greater number of designated stroke centers within a 2-mile radius (4.8 vs. 2.7; P = .002).
According to the study, mobile stroke unit care was associated with a mean decrease in dispatch-to-thrombolysis time of 29.7 minutes (95% CI, 6.9-52.5) compared with conventional ambulance.
“When it comes to stroke treatment, 30 minutes can be the difference between making a full recovery from a stroke and living independently, or becoming disabled and needing help with the activities of daily living,” Matthew E. Fink, MD, chair of neurology and the Louis and Gertrude Feil Professor in Clinical Neurology at Weill Cornell Medicine in New York and neurologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center, said in a press release. “The faster patients receive alteplase, the more likely they are to recover quickly and with fewer complications.”
In other findings, patients picked up by a mobile stroke unit experienced a mean increase in dispatch-to-ambulance arrival time of 6.5 minutes (95% CI, 2.4-10.6), which was offset by a mean decrease in ambulance arrival-to-thrombolysis time of 36.2 minutes (95% CI, –58.5 to –13.9), according to the study.
“This study provides further evidence suggesting a potential role for mobile stroke units in dense urban areas to increase our ability to treat stroke patients faster,” Lee H. Schwamm, MD, executive vice chairman of neurology and director of the MGH Comprehensive Stroke Center at Massachusetts General Hospital, said in the release. “This study joins a large body of efforts to improve how we swiftly recognize, triage, transport and treat patients with stroke, which is the ultimate goal.”
Design and limitations
Researchers assessed 66 patients with suspected acute ischemic stroke who were transported by a bi-institutional mobile stroke unit operating in Manhattan between October 2016 and September 2017 and compared their experiences with 19 patients picked up via conventional ambulance during hours of mobile stroke unit operation (Monday-Friday, 9 a.m.-5 p.m.).
“The overall study population size was small, and our comparison group was considerably smaller than the mobile stroke unit group,” the researchers wrote. “While smaller, however, the comparison group was identified in a prospective manner using strict, predefined criteria, including emergency medical services call-types and stroke prenotification systems that were as similar as possible to those used to activate the mobile stroke unit, ensuring as close a comparison as possible.”
Findings were adjusted for clinical, demographic and geographic factors, including the number of nearby designated stroke centers as well as population density, according to the study.
Future research
“We know that faster treatment equals better outcomes. However, further research is needed to establish if mobile stroke units improve long-term health outcomes and are a cost-effective solution in stroke systems of care for large cities, as they reflect a significant financial investment for cities and EMS agencies,” Schwamm said in the release. “While the lack of definitive evidence of benefit and of third-party reimbursement for mobile stroke unit staffing and care are barriers, additional studies are ongoing and will help address these critical issues.” – by Scott Buzby
Disclosures: Fink reports he serves as an editor for Relias Learning. The other authors report no relevant financial disclosures. Schwamm reports he consults for LifeImage, Medtronic and Penumbra.