Mobile Stroke Unit Decreases Time to Imaging, Treatment

NASHVILLE — Patients treated with thrombolysis in a mobile stroke unit had decreased time to imaging and treatment when compared with patients who were brought to the emergency department via a traditional ambulance, according to results presented at the International Stroke Conference 2015.

Muhammad Shazam Hussain, MD, of the Cleveland Clinic Stroke Program, and colleagues undertook the study after they saw compelling data from two centers in Germany. “[These data] showed that time to treatment could be greatly improved utilizing a mobile stroke treatment unit [MSTU],” he said. “After a visit to Germany in July 2013, we moved forward with establishing our own MSTU.”

Hussain and colleagues initiated the MSTU at the Cleveland Clinic on July 18, 2014, which featured a registered nurse, paramedic, emergency medical personnel and a computed tomography (CT) technologist. A stroke physician used telemedicine to assess patients, and a neuroradiologist and stroke physician remotely evaluated images acquired through CereTom mobile CT (NeuroLogica).

The study included 23 patients who were treated in the MSTU and 34 in the traditional ambulance (control).

Researchers entered data in medical records and a prospective registry, and compared the evaluation and treatment in the first three weeks of implementation of MSTU with the control group, which was brought to the emergency department during the preceding three months.

Median time from alarm — defined as city emergency medical service dispatch time — to MSTU scene arrival was 13 minutes (interquartile range, 9-17). Researchers reported a significant reduction in the MSTU group in median alarm-to-CT scan completion times (41 minutes vs. 62 minutes; P<.0001) and median alarm-to-thrombolysis times (64 minutes vs. 104 minutes; P<.008).

Among patients in the MSTU group, six (26%) received thrombolysis compared with five (14%) in the control group. No early complications of thrombolysis were reported in the MSTU group.

“In the first six months of our program, we have been able to show the same time savings as were realized by the German studies — approximately 30 to 40 minutes of time savings in the administration of [intravenous tissue plasminogen activator],” Hussain said. “Through the use of new technology, particularly the use of telemedicine, we have been able to offer care efficiently and effectively in the pre-hospital setting. This will likely be a great advancement for stroke care, and we may see pre-hospital care of other diseases as well.”

For more coverage of the International Stroke Conference 2015, go here.

Reference

1. Hussain MS et al. Abstract 54. Presented at: International Stroke Conference 2015; Feb. 11-13, 2015; Nashville, Tennessee.