Receiving a clot-busting drug in an ambulance-based mobile stroke unit increases the likelihood of averting strokes and complete recovery. US researchers now plead for mobile solutions.
The study, published in the Annals of Neurology, determined that mobile stroke unit (MSU) care was associated with both increased odds of averting stroke compared with hospital emergency medical service (EMS) (18 % versus 11 %) and a higher percentage of patients having early symptom resolution, within 24 hours after stroke (31 % versus 21 %).
Patients in this study were treated with tissue plasminogen activator (t-PA), a mainstay medication delivered intravenously (IV) in stroke cases. The drug dissolves the clot in an artery that is blocking blood flow to the brain, making treatment time critical. “While this is known to improve patient outcomes, how many patients fully recover afterward wasn’t clear from prior research,” said lead author Dr. Babak Benjamin Navi, associate professor and chief of stroke and hospital neurology at Weill Cornell Medicine.
“On average, the faster you treat someone, the more likely you are to have a good functional outcome because you’re able to preserve more brain tissue,” Dr. Navi said, associate professor of neuroscience at Weill Cornell and medical director of the stroke center. “The brain can only sustain reduced blood flow for so long before permanent injury develops.” Using multicenter trial data from 2014–2020, the researchers evaluated 1,009 patients: 644 received t-PA in an MSU, and 365 received EMS care. Overall, patients received t-PA at a median interval of 87 minutes after the onset of stroke symptoms. The study found that with t-PA treatment in this time frame, about one in four patients who had a suspected stroke recovered within 24 hours and one in six averted a stroke with no demonstrable trace of brain injury on an MRI.
The outcome improved for patients treated by an MSU since the time from symptom onset to treatment was 37 minutes faster than for EMS care, meaning many more patients received vital t-PA within the crucial first hour. MSU care further increased the odds of averting a stroke with nearly one-third of patients recovering to normal within 24 hours. In addition, the researchers found other factors that contributed to better patient outcome: treatment within the first 45 minutes, younger age, being female, history of high cholesterol, lower blood pressure, lower stroke severity and no blockage of large blood vessels.
Every 40 seconds, someone in the United States has a stroke, according to the American Heart Association. The study highlights the need for optimizing stroke systems of care, Dr. Navi said. Further expediting the delivery of t-PA through MSUs should be a priority to increase the proportion of averted strokes. Dr. Navi is also hoping that Medicare will assign MSU services a billing code in the near future so that it can be embedded within stroke systems of care and become a financially viable model.
Currently, he is working with researchers from UTHealth Houston on a study to evaluate the cost effectiveness of MSUs, which should be published next year. “Such studies will hopefully lead to a shift in regulations and reimbursements, and how MSUs are led, managed and integrated within emergency medical services,” he said.
This article is based on a press release by Weill Cornell Medicine. You can find the original publication here and by following the link in our text.
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