Lancet: When stroke strikes, mobile units are twice as effective as EMS

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Source: National Institute of Mental Health
Emergency responders equipped with mobile stroke units (MSUs) can roughly halve the time it normally takes to get suspected stroke patients from the initial call for help to treatment decision, potentially increasing the number of patients able to receive life-saving, damage-reducing treatment.

That’s according to a new study published online April 11 in The Lancet Neurology.
“Stroke is a medical emergency for which ‘time is brain’; however, most patients still arrive at hospital too late to receive necessary treatment,” wrote neurologist Klaus Fassbender, MD, of Saarland University in Germany, et al. “We show that MSU­-based stroke management substantially breaks, to our knowledge, all reported times for stroke management.”

In the study, 100 patients with a suspected stroke were randomly assigned to receive either treatment before they reached hospital in an MSU outfitted with a CT scanner, point-of-care laboratory and telemedicine capabilities (53 patients) or standard hospital-based stroke treatment (47 patients). The researchers found the median time from alarm to therapy decision was 41 minutes shorter with MSU than with conventional stroke management, with a median time from symptom onset to therapy decision of 56 minutes.

They also found that pre-hospital, MSU-enabled treatment substantially reduced the median time from emergency call to therapy decision compared with hospital care (35 minutes vs. 76 minutes). Plus, the MSU lowered the time from symptom onset to therapy decision time to less than an hour for 57 percent of patients compared with just 4 percent in the hospital-care group.

Finally, the time from alarm to clot-busting thrombolysis was substantially shorter in the MSU group—38 minutes vs. 73 minutes.

The trial was stopped early after a planned interim analysis at 100 of 200 planned patients because pre-specified criteria for study termination had been met.

In a comment published along with the article, British neurologists Peter M. Rothwell, MD, and Alastair M. Buchan, MD, both of Oxford University, pointed out that the real-world adaptability of the study findings will likely vary according to the setting.

“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,” they wrote. “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.”