Mobile Stroke Treatment Units - specialized emergency rooms on wheels - are saving critical minutes in the diagnosis and treatment of stroke patients, according to two new studies presented at the American Stroke Association's International Stroke Conference 2015.
"Due to how critical time is in the treatment of stroke, using Mobile Stroke Treatment Units (MSTU) to provide pre-hospital evaluation and treatment of stroke should revolutionize the care of these patients," said Muhammad Shazam Hussain, M.D., lead researcher (abstract 54) and head of the Cleveland Clinic Stroke Program.
MSTUs are specialized ambulances staffed with a nurse, paramedic, emergency personnel and CT technologist. The unit also contains lab testing equipment and a CT scanner, which is required to diagnose the type of stroke. A stroke physician at the main hospital evaluated each patient via telemedicine and a neuroradiologist remotely assessed CT images. Two-way video conferencing allowed communication with the patient, family and stroke experts.
The CT image is an important diagnostic test distinguishing a hemorrhagic (bleeding) stroke from ischemic stroke (blood clot blocking vessels and blood flow). The treatment for these types of strokes is different, and cannot be started until the CT scan is complete.
In this analysis, researchers report the evaluation and treatment in the first three weeks of implementation of the MSTU in Cleveland as compared to a control group of patients brought to the emergency department via traditional ambulance in the preceding three months. They measured the time from call dispatch from emergency medical service (time of alarm) to the time a CT was completed and clot-busting treatment with tPA was started.
Twenty-three patients were treated in the MSTU and 34 in the emergency room. There were no significant differences in age or gender between the groups. Researchers found:
"Estimates are that stroke victims lose two million neurons (brain cells) per minute, so this reduction in time with the MSTU could potentially result in much better outcomes," Hussain said.
In addition, researchers noted the rate of clot-buster treatment was much higher in the MSTU than in the hospitals (26 percent vs. 14 percent). This also was much higher than the national average of 3 percent to 8 percent.
"The main reason for patients not getting treated is that they do not arrive in time for this treatment - 4.5 hours from symptom onset," Hussain said.
Hussain noted that another advantage of the mobile unit is being able to triage patients to the most appropriate hospital for their condition. An ischemic stroke patient with a large clot sitting in a major brain artery usually requires catheter-based treatment - available in larger facilities - in addition to an IV clot buster.
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Mobile stroke units improve response times, outcomes for patients