Mobile stroke units deliver ten-fold increase in early thrombolysis: study


By Mardi Chapman

23 Mar 2021

Mobile stroke units (MSU) increase the proportion of people treated with tPA and especially during the first “golden hour”.

Dr Jim Grotta, from the Houston Mobile Stroke Unit and director of stroke research at the Memorial Hermann Hospital-Texas Medical Center, presented the results of the multi-site BEST-MSU trial at the International Stroke Conference (ISC21).

He said the trial found a significant increase in tPA use in the first hour in patients treated by a mobile stroke unit compared to patients receiving standard management (33% v 3%).

The mobile stroke unit also significantly increased the proportion of patients treated with tPA within 4.5 hours (97.1% v 79.1%).
Dr Grotta said there was also a 10% increase in the proportion of patients who achieved an mRS score of 0 or 1 – 55.0% when treated in the mobile stroke unit versus 44.4% of those who received standard management.

The study, located at seven US sites, was still to evaluate health care utilisation.

However Dr Grotta said because the mobile stroke unit was essentially curing more patients, he was confident that downstream healthcare utilisation would be reduced.

“If we reverse just five more strokes per year, the cost of buying a mobile stroke unit and implementing it would be offset,” he said in an interview.

Commenting on the study, Professor Christopher Bladin told the limbic the researchers had shown some impressive results.

“33% with mobile stroke unit v 3% with standard treatment. Unquestionably, the earlier you treat patients the better the outcomes will be so that is a massive benefit for patients with acute stroke.”

“The other interesting thing is that they only had a low number of stroke mimicks. There are a lot of things that can look like a stroke but in fact their service was able to remain very targeted which is encouraging.”

He said the 90-day outcomes were also hugely impressive as well.

Professor Bladin, Director of the Victorian Stroke Telemedicine program, said importantly there were also no safety issues.

“There was only a 2% haemorrhage rate in both the MSU group and the standard management group.”

“So as we are hearing with vaccines, it’s not just about does the vaccine work, but is it safe to use? Similarly with the MSU. With all our medical care, is what we are doing actually safe and this new innovation of stroke ambulance is as safe as what we would do conventionally treating in a hospital but delivering better care, more care and faster care to stroke patients. What’s not to like about that?”

“The study from the Texas group confirms and expands the information we were getting from the stroke ambulance studies in Europe, and Germany in particular. It …really opens up the door for expansion of this type of service in other capital cities in Australia.”

“We now have excellent randomised clinical trials that have clearly shown the benefits so the health case is demonstrated. We have information coming down on the health economics around this but there is no question that when you have many more people getting better outcomes, returning to independent lifestyles, working and fully functional in the community, then the health economics will quickly stack up too.”

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