A study, published Online First in The Lancet Neurology, reveals that using a mobile stroke unit (MSU) to evaluate and treat suspected stroke patients at the site of the emergency approximately reduces the time from the initial emergency call to treatment decision by half. In addition, using MSU could also increase how many patients are eligible for life-saving treatment.

Lead author of the study, Klaus Fassbender from the University of the Saarland, Homburg, Germany, said:

“The MSU strategy offers a potential solution to the medical problem of the arrival of most stroke patients at the hospital too late for treatment…and substantially breaks, to our knowledge, all reported times of stroke management.”

At present, thrombolysis using the clot-busting drug alteplase (recombinant tissue plasminogen activator) is the only treatment for acute ischemic stroke and must be administered within 4.5 hours of symptom onset. In an ischemic stroke, the blood supply to part of the brain is cut off or reduced.
Prior to treatment, patients must undergo computed tomography (CT) scans of the brain in order to verify that a clot is the cause of the stroke.

According to the researchers, less than 15% to 40% of suspected stroke patients arrive at the hospital early enough to receive thrombolysis. Furthermore, only 2% to 5% of eligible patients are estimated to actually receive the treatment.

The researchers randomly assigned 53 patients with a suspected stroke to receive treatment in a MSU equipped with a CT scanner, point-of-care laboratory, and telemedicine before they reached hospital, and 47 patients to receive optimized standard hospital-based stroke treatment.

The team found that the median time from emergency call to treatment decision using MSU was 35 minutes, compared with 76 minutes for hospital care. In addition, MSU reduced the duration of time from symptom onset to treatment decision to under an hour for 57% of patients, compared with 4% of patients assigned to hospital care.

The team also found MSU considerably reduced the length of time from emergency call to thrombolysis (38 min), compared with hospital care (73 min). The researchers explain:

“According to the generally accepted ‘time is brain’ concept, such a large reduction in delay should translate into improved outcome…although in secondary analyses no significant difference was recorded in the numbers of patients who received thrombolysis or in neurological outcome.”

They conclude:

“Although the effect on clinical outcome needs further study in larger (e.g. multicenter) trials, the results of this first randomized trial of the MSU strategy of bringing the hospital to the patient with stroke show that guideline-adherent diagnosis and therapy can be reliably delivered within the first 35 min after alarm, thus speeding up acute stroke management.”

In an associated comment, Peter Rothwell and Alastair Buchan from Oxford University, UK, explained:

“The generalizability of the trial findings to potential MSU services elsewhere will depend very much on the setting. This trial was set in an urban area with a median distance from the patient to the hospital of 7km and median alarm to arrival times of 8 minutes for the standard ambulance versus 12 minutes for the MSU.

The MSU would potentially work less well in rural areas in which locally based ambulances might be able to get patients to hospital about as quickly as a hospital-situated MSU could get out to the patient.

Nevertheless, this trial has shown convincingly that in at least some settings an MSU-based service is feasible and can substantially reduce delays to treatment.”

Written By Grace Rattue