Mobile units improve outcomes in patients with acute ischemic stroke

SEATTLE — Mobile stroke units were linked with improved outcomes compared with conventional emergency medical services for people with acute ischemic stroke, a presenter said at the 2022 American Academy of Neurology annual meeting.

“A mobile stroke unit is an ambulance that has a CT scanner on the rig with a critical care nurse and point-of-care labs and sometimes vascular neurologist either by telemedicine or in person,” Bay Leslie-Mazwi, MD, the Warren and Jermaine Magnuson Endowed Chair in Medicine for Neurosciences at the University of Washington, said at the meeting. “The goal of the ambulance is to give alteplase on board by bringing the emergency department to the patient's doorstep.”

According to Leslie-Mazwi, the concept began in Germany with double dispatching. When 911 is called, and there is a possibility of a stroke, both a regular ambulance and a mobile stroke unit (MSU) are sent. If it is a stroke, the MSU stays and continues care. If not, the ambulance will take the patient to the nearest emergency department.

“The goal of the mobile stroke unit is faster thrombolysis; that's how the idea began,” he said.

Presenting data from a 2021 Berlin-based, nonrandomized study, Leslie-Mazwi said it was the first demonstration of MSUs improving outcomes for stroke patients. “What they found is that in patients that had a stroke for whom a mobile stroke unit was dispatched, outcomes of 3 months were improved.”

Leslie-Mazwi cited a randomized trial conducted in Houston, which found that the time from onset of stroke to treatment in MSUs was 72 minutes, compared with 108 minutes for those receiving treatment from conventional emergency medical services (EMS). Further, the time from calling emergency services to treatment was 46 minutes for MSUs, compared with 78 minutes for EMS.

“The question is — should we all get mobile stroke units? The answer is an intriguing one,” he said. “It likely depends on your geography and how your local ambulance services work. We do know, though, that mobile stroke units improve patient outcomes.”

References:

Ebinger M, et al. JAMA. 2021;doi:10.1001/jama.2020.26345.

Grotta JC, et al. N Engl J Med. 2021;doi:10.1056/NEJMoa2103879.