Ischemic stroke patients treated on a mobile stroke unit (MSU) received anti-clot medication faster and ended up with less disability at 90 days, according to a US study.
Study results showed that patients treated on an MSU were more likely to receive the clot-busting drug tissue plasminogen activator (tPA) – 97 per cent compared to 80 per cent with an emergency medical services (EMS) ambulance.
They were also more likely to receive it in the first hour after a stroke. Mortality at 90 days was 9 per cent for MSU versus 12 per cent for EMS.
“The study revealed that for every 100 patients treated with an MSU rather than by standard ambulance, 27 will have less final disability and 11 more will be disability-free,” said James C. Grotta, director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann-TMC, in Texas.
Co-author Stephanie Parker, manager of the UTHealth Mobile Stroke Unit Program in Houston, added: “Stroke affects an entire family, not just the patient. That’s why it’s so important to find ways to decrease a patient’s disability and improve their quality of life.”
The study began in 2014 with the launch of the UTHealth Mobile Stroke Unit, the first MSU in the US, through a partnership with the Houston Fire Department and other local fire departments, as well as hospitals. The clinical trial compared outcomes for alternate weeks of service by the MSU or EMS.
Mobile stroke units are special ambulances equipped with a computed tomography (CT) scanner and are staffed by personnel trained to diagnose and treat stroke patients in the pre-hospital setting, including paramedics, a CT technologist, and a critical care nurse. A neurologist is available either onboard or via telemedicine.
Jose-Miguel Yamal, PhD, lead of the data coordinating center for the trial, said: “If mobile stroke units are more widely adopted, this could have a large impact on public health by changing the practice of pre-hospital care.
“As we have learned in this trial, close integration and collaboration with the local emergency management systems is integral to the success of mobile stroke units. Embedding mobile stroke units into the EMS system has a huge pay off by being able to treat more stroke patients in those first critical hours after stroke.”
The trial, which ran from 2014 to 2020 and enrolled more than 1,500 patients, eventually expanded across the country to include six additional sites: University of Tennessee in Memphis; New York Presbyterian (Weill Cornell and Columbia University); Indiana University Health; Sutter Health in Burlingame, California; University of California-Los Angeles; and University of Colorado-Anschutz Campus in Aurora and Colorado Springs, Colorado.
Initially, the UTHealth Mobile Stroke Unit carried a vascular neurology specialist on board, with Grotta; Ritvij Bowry, MD; and other UTHealth neurologists rotating the duty. A subsequent study published in 2017 showed that telemedicine could replace the neurologist on board the MSU, which lowered costs.
A comparison of healthcare resource utilisation is currently being analysed.
“More widespread deployment of mobile stroke units may have a major public health impact on reducing disability from stroke,” said Grotta.
“Although mobile stroke units are costly to equip and staff, they reduce the time to treatment, and we expect that mobile stroke units will reduce the need for downstream utilisation of long-term care.”
