Conference Coverage
NASHVILLE—Patients who were treated by a new mobile stroke unit had their CT scans read sooner and received thrombolysis more quickly, compared with patients who first were taken to the hospital, according to data presented at the 2015 International Stroke Conference.
The findings were based on the first three weeks of operation of a unit implemented by the Cleveland Clinic in July 2014. The unit is the second mobile stroke unit in the United States. The first unit, operated by the University of Texas Health Science Center at Houston, treated its first patient in May 2014.
The Cleveland mobile stroke unit uses an ambulance equipped with a CT scanner and is staffed with a nurse, a paramedic, emergency personnel, and a CT technologist. A stroke physician at the main hospital evaluated each patient via two-way video conferencing, and a neuroradiologist remotely assessed CT images to distinguish hemorrhagic stroke from ischemic stroke so responders could begin treatment.
Muhammad Shazam Hussain, MD, head of the Cleveland Clinic Stroke Program, and colleagues compared median imaging and treatment times for 23 patients who were treated by the new mobile stroke unit with median times for 34 patients in a control group who were brought to the emergency department by traditional ambulance in the preceding three months. There were no significant differences in age or gender between the groups.
Median Time to Complete CT Scan Was Reduced
Researchers found a significant reduction in the median time from when ambulances were dispatched to when CT scans were completed (41 minutes in the mobile unit group vs 62 minutes in the emergency department group) and to when thrombolysis started (64 minutes in the mobile unit group vs 104 minutes in the emergency department group).
Six patients in the mobile stroke treatment unit group (26%) received thrombolysis, compared with five patients in the emergency department group (14%). There were no early complications of treatment in the mobile stroke treatment unit group.
Researchers also examined the median time from when patients last were known to be well to when the patients received thrombolysis (115 minutes in the mobile unit group vs 125 minutes in the emergency department group) and the median time from when ambulances were dispatched to when CT scans were read (52 minutes in the mobile unit group vs 67.5 minutes in the emergency department group). The median time from when the mobile stroke unit was dispatched to when it arrived on scene was 13 minutes.
“Due to how critical time is in the treatment of stroke, using mobile stroke treatment units to provide prehospital evaluation and treatment of stroke should revolutionize the care of these patients,” said Dr. Hussain, lead researcher for the Cleveland study. “Estimates are that stroke victims lose two million neurons per minute, so this reduction in time with the mobile stroke treatment unit could potentially result in much better outcomes.”
Another advantage of the mobile unit is the ability to triage patients to the most appropriate hospital for their condition, Dr. Hussain said. For example, a patient with a large clot in a major brain artery could be sent directly to a larger hospital for catheter-based treatment. “We eliminate the need to transfer them from a small hospital to a larger hospital by getting them there directly, [thus] saving critical time and making the difference between patients being able [and unable] to receive advanced, lifesaving treatments,” Dr. Hussain said.
Creating the First Mobile Stroke Unit in the US
In another study presented at the conference, researchers at the University of Texas Health Science Center at Houston reported how they created the first mobile stroke unit in the US. The Houston unit responds to acute stroke dispatches within a five-mile radius from 8 a.m. to 6 p.m. daily. Unit staff members start acute stroke treatment within 10 to 18 minutes of arrival, researchers said. During a nine-week run-in phase, approximately two patients per week were treated with rt-PA on the mobile stroke unit, and 40% of them were treated within the first hour of symptom onset, said Stephanie A. Parker, RN, BSN, project manager of the UTHealth Mobile Stroke Unit.
“Our ultimate goal is to show that patients treated on the mobile stroke unit will have better outcomes because of earlier treatment” and will have fewer long-term acute care and rehabilitation needs, Dr. Parker said. The world’s first mobile stroke unit was implemented in Germany in 2008.