Study results revealed that patients treated on an MSU were more likely to receive the clot-busting drug tissue plasminogen activator (tPA) – 97 percent compared to 80 percent with an emergency medical services (EMS) ambulance, and more likely to receive it in the first hour after a stroke. Mortality at 90 days was 9 percent for MSU versus 12 percent for EMS.
"Stroke affects an entire family, not just the patient," said Stephanie Parker, MHA, BSN, RN, co-primary author and manager of the UTHealth Mobile Stroke Unit Program. "That's why it's so important to find ways to decrease a patient's disability and improve their quality of life." Parker is with the Department of Neurology in McGovern Medical School at UTHealth Houston.
Mobile stroke units are special ambulances equipped with a computed tomography (CT) scanner and are staffed by personnel trained to diagnose and treat stroke patients in the pre-hospital setting, including paramedics, a CT technologist, and a critical care nurse. A neurologist is available either onboard or via telemedicine.
"If mobile stroke units are more widely adopted, this could have a large impact on public health by changing the practice of pre-hospital care," said Jose-Miguel Yamal, PhD, co-primary author and lead of the data coordinating center for the trial. "As we have learned in this trial, close integration and collaboration with the local emergency management systems is integral to the success of mobile stroke units. Embedding mobile stroke units into the EMS system has a huge pay off by being able to treat more stroke patients in those first critical hours after stroke." Yamal is professor of biostatistics and director of the Coordinating Center for Clinical Trials within UTHealth Houston School of Public Health.
"One of the things I am most proud of here in Houston is that an important study could be done that integrated the medical community and fire department," said David Persse, MD, medical director of the Houston Fire Department-Emergency Medical Services. "That took a tremendous amount of integration and trust and one really important part was the Houston Mobile Stroke Unit Consortium."
"More widespread deployment of mobile stroke units may have a major public health impact on reducing disability from stroke," said Grotta, who is a member of the UTHealth Institute for Stroke and Cardiovascular Diseases. "Although mobile stroke units are costly to equip and staff, they reduce the time to treatment, and we expect that mobile stroke units will reduce the need for downstream utilization of long-term care."
Bowry was a stroke fellow at UTHealth when the MSU was unveiled. He is now a neurologist who specializes in neurocritical care within the Department of Neurology and Vivian L. Smith Department of Neurosurgery at McGovern Medical School and senior author on the study.
"We've always known every minute counts," Bowry said. "The challenge has been to identify and execute a faster treatment strategy that will benefit ischemic stroke patients. We live in the fourth-largest city in the country and are one of the most diverse. But when it comes to stroke, it’s a significant cause of death and severe disability in all people. To fundamentally change that has been a rewarding and groundbreaking personal and professional moment for all of us."
MEDICA-tradefair.com; Source: University of Texas Health Science Centre Houston
