Mobile Stroke Unites improve Outcomes in Patients of Acute Ischemic Stroke: JAMA

Ischemic stroke, the most common type of stroke, restoring blood flow as quickly as possible is the key approach. This treatment strategy is called "time is brain". Effects of thrombolysis in acute ischemic stroke are time-dependent. Ambulances that can administer thrombolysis (mobile stroke units [MSUs]) before arriving at the hospital have been shown to reduce time to treatment.

However, is still unclear if earlier treatment in a mobile stroke unit improves long-term functional outcomes. Therefore, researchers of Berlin, Germany, conducted a study to determine whether the dispatch of MSUs is associated with better clinical outcomes for patients with acute ischemic stroke.

It was a prospective, nonrandomized, controlled intervention study was conducted in Berlin, Germany, from February 1, 2017, to October 30, 2019. If an emergency call prompted suspicion of stroke, the MSU (computed tomographic scanning with or without angiography, point-of-care laboratory testing, and thrombolysis capabilities onboard) with conventional ambulance or the conventional ambulance alone were simultaneously dispatched depending upon their availability. Researchers included a total of 1,543 patients, among them, 749 received both the mobile stroke unit and a conventional ambulance, and 794 received a conventional ambulance only. The major outcome assessed was the distribution of the modified Rankin Scale (mRS) scores (a disability score ranging from 0, no neurological deficits, to 6, death) at 3 months. They also assessed a 3-tier disability scale at 3 months (none to moderate disability; severe disability; death) with tier assignment based on mRS scores if available or place of residence if mRS scores were not available.

Key findings of the study were:

♦ The researchers noted, among 1,543 patients, 1337 (87%) had available mRS scores (primary outcome) and, 1506 patients (98%) had available the 3-tier disability scale assessment (coprimary outcome).

♦ They found that the sending a mobile stroke unit improved patient outcomes at three-month follow-up, with those who received the mobile unit having median modified Rankin scale scores of 1 compared with 2 for those to whom a mobile unit was not sent.

♦ They also found that patients with an MSU dispatched had lower 3-month coprimary disability scores:

                        • 586 patients (80.3%)none to moderate disability

                        • 92 (12.6%) had a severe disability and

                        • 52 (7.1%) had died.

♦ Whereas, among patients without an MSU dispatched they found

                        • 605 (78.0%) had none to moderate disability

                        • 103 (13.3%) had severe disability and

                        • 68 (8.8%) had died.

The authors concluded, " In this prospective, nonrandomized, controlled intervention study of patients with acute ischemic stroke in Berlin, Germany, the dispatch of mobile stroke units, compared with conventional ambulances alone, was significantly associated with lower global disability at 3 months. Clinical trials in other regions are warranted."

For further information:

https://jamanetwork.com/journals/jama/article-abstract/2775714