Impact of mobile stroke units

Since its first introduction in clinical practice in 2008, the concept of mobile stroke unit enabling prehospital stroke treatment has rapidly expanded worldwide. This review summarises current knowledge in this young field of stroke research, discussing topics such as benefits in reduction of delay before treatment, vascular imaging-based triage of patients with large-vessel occlusion in the field, differential blood pressure management or prehospital antagonisation of anticoagulants. However, before mobile stroke units can become routine, several questions remain to be answered. Current research, therefore, focuses on safety, long-term medical benefit, best setting and cost-efficiency as crucial determinants for the sustainability of this novel strategy of acute stroke management.

[1]  B. Mackert,et al.  Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin. , 2021, JAMA.

[2]  Eric E. Smith,et al.  Trends in Reperfusion Therapy for In-Hospital Ischemic Stroke in the Endovascular Therapy Era. , 2020, JAMA neurology.

[3]  A. Demchuk,et al.  Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke , 2020, Neurology.

[4]  I. Grunwald,et al.  Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions , 2020, Cerebrovascular Diseases.

[5]  M. Hernández-Pérez,et al.  Deep Learning Based Software to Identify Large Vessel Occlusion on Noncontrast Computed Tomography , 2020, Stroke.

[6]  J. Grotta,et al.  Enhanced dispatch and rendezvous doubles the catchment area and number of patients treated on a mobile stroke unit. , 2020, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[7]  J. Grotta,et al.  Prehospital stroke management in the thrombectomy era , 2020, The Lancet Neurology.

[8]  G. Donnan,et al.  Economic evaluation of the Melbourne Mobile Stroke Unit , 2020, International journal of stroke : official journal of the International Stroke Society.

[9]  A. Shuaib,et al.  Mobile stroke unit versus standard medical care in the management of patients with acute stroke: A systematic review and meta-analysis , 2020, International journal of stroke : official journal of the International Stroke Society.

[10]  K. Butcher,et al.  Successful dabigatran reversal after subdural hemorrhage using idarucizumab in a mobile stroke unit , 2020, Medicine.

[11]  M. Hill,et al.  In What Scenarios Does a Mobile Stroke Unit Predict Better Patient Outcomes? , 2020, Stroke.

[12]  J. Grotta,et al.  Mobile Stroke Unit Computed Tomography Angiography Substantially Shortens Door-to-Puncture Time , 2020, Stroke.

[13]  A. Alexandrov,et al.  Innovations in Prehospital Stroke Management Utilizing Mobile Stroke Units. , 2020, Continuum.

[14]  Jeffrey Chang Unit , 2020, Encyclopedic Dictionary of Archaeology.

[15]  Benjamin R. Kummer,et al.  Geographic Analysis of Mobile Stroke Unit Treatment in a Dense Urban Area: The New York City METRONOME Registry , 2019, Journal of the American Heart Association.

[16]  J. Guldner,et al.  Prehospital Stroke Management Optimized by Use of Clinical Scoring vs Mobile Stroke Unit for Triage of Patients With Stroke: A Randomized Clinical Trial. , 2019, JAMA neurology.

[17]  V. Srikanth,et al.  Googling Location for Operating Base of Mobile Stroke Unit in Metropolitan Sydney , 2019, Front. Neurol..

[18]  R. Kowalski,et al.  Integration of Real-Time Electronic Health Records and Wireless Technology in a Mobile Stroke Unit. , 2019, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[19]  A. D. de Havenon,et al.  Diurnal Variations in the First 24/7 Mobile Stroke Unit. , 2019, Stroke.

[20]  M. Mazighi,et al.  European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE) , 2019, European stroke journal.

[21]  A. Demchuk,et al.  Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors , 2019, The New England journal of medicine.

[22]  G. Donnan,et al.  Prehospital idarucizumab prior to intravenous thrombolysis in a mobile stroke unit , 2018, International journal of stroke : official journal of the International Stroke Society.

[23]  J. Røislien,et al.  Stroke severity quantification by critical care physicians in a mobile stroke unit , 2017, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[24]  G. Donnan,et al.  Air-Mobile Stroke Unit for access to stroke treatment in rural regions , 2018, International journal of stroke : official journal of the International Stroke Society.

[25]  E. Metter,et al.  Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance , 2018, Interventional Neurology.

[26]  A. Shuaib,et al.  The mobile stroke unit and management of acute stroke in rural settings , 2018, Canadian Medical Association Journal.

[27]  H. Shownkeen,et al.  E-112 A single center comparison of stroke treatment times: impact of a mobile stroke unit , 2018, Electronic Poster Abstracts.

[28]  J. Grotta,et al.  Time to Decision and Treatment With tPA (Tissue-Type Plasminogen Activator) Using Telemedicine Versus an Onboard Neurologist on a Mobile Stroke Unit , 2018, Stroke.

[29]  O. Zaidat,et al.  World’s First 24/7 Mobile Stroke Unit: Initial 6-Month Experience at Mercy Health in Toledo, Ohio , 2018, Front. Neurol..

[30]  K. Furie,et al.  2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. , 2018, Stroke.

[31]  W. Powers,et al.  2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2018, Stroke.

[32]  George Hripcsak,et al.  Clinical Information Systems Integration in New York City's First Mobile Stroke Unit , 2018, Applied Clinical Informatics.

[33]  Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. , 2018, Stroke.

[34]  I. Grunwald,et al.  Prehospital Computed Tomography Angiography in Acute Stroke Management , 2017, Cerebrovascular Diseases.

[35]  C. Lund,et al.  Pre-hospital ct diagnosis of subarachnoid hemorrhage , 2017, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[36]  J. Grotta,et al.  Telemedicine Can Replace the Neurologist on a Mobile Stroke Unit , 2017, Stroke.

[37]  Eric E. Smith,et al.  Treatment With Tissue Plasminogen Activator in the Golden Hour and the Shape of the 4.5-Hour Time-Benefit Curve in the National United States Get With The Guidelines-Stroke Population , 2017, Circulation.

[38]  S. Lageman,et al.  National Institute of Neurological Disorders and Stroke , 2017 .

[39]  Adnan H Siddiqui,et al.  Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. , 2016, JAMA.

[40]  Thomas Lindner,et al.  Comparison of Perfusion CT Software to Predict the Final Infarct Volume After Thrombectomy , 2016, Stroke.

[41]  A. Rai,et al.  A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA , 2016, Journal of NeuroInterventional Surgery.

[42]  K. Uchino,et al.  Performance of CT Angiography on a Mobile Stroke Treatment Unit: Implications for Triage , 2016, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[43]  M. Reeves,et al.  Dispatcher Stroke Recognition Using a Stroke Screening Tool: A Systematic Review , 2016, Cerebrovascular Diseases.

[44]  I. Grunwald,et al.  First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit , 2016, Cerebrovascular Diseases.

[45]  I. Grunwald,et al.  Prehospital Imaging‐Based Triage of Head Trauma with a Mobile Stroke Unit: First Evidence and Literature Review , 2016, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[46]  J. Grotta,et al.  Radiation Monitoring Results from the First Year of Operation of a Unique Ambulance-based Computed Tomography Unit for the Improved Diagnosis and Treatment of Stroke Patients , 2016, Health physics.

[47]  Andrew P. Reimer,et al.  Telemedicine in Prehospital Stroke Evaluation and Thrombolysis: Taking Stroke Treatment to the Doorstep. , 2016, JAMA neurology.

[48]  J. Grotta,et al.  Benefits of Stroke Treatment Using a Mobile Stroke Unit Compared With Standard Management: The BEST-MSU Study Run-In Phase , 2015, Stroke.

[49]  J. Røislien,et al.  Assessment of acute stroke cerebral CT examinations by anaesthesiologists , 2015, Acta anaesthesiologica Scandinavica.

[50]  D. Gyrd-Hansen,et al.  Cost-effectiveness estimate of prehospital thrombolysis , 2015, Neurology.

[51]  Eli Segal,et al.  Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. , 2015, CJEM.

[52]  Andrew P. Reimer,et al.  Abstract 54: Reduction in time to Imaging and intravenous Thrombolysis by in-field Evaluation and Treatment in a Mobile Stroke Treatment Unit , 2015 .

[53]  J. Grotta,et al.  Abstract 52: Establishing the First Mobile Stroke Unit in the United States , 2015, Stroke.

[54]  Michal Rozanski,et al.  Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. , 2015, JAMA neurology.

[55]  S. Levine,et al.  Is Prehospital Treatment of Acute Stroke too Expensive An Economic Evaluation Based on the First Trial , 2014, Cerebrovascular Diseases.

[56]  M. Hill,et al.  Alteplase in acute ischaemic stroke: the need for speed , 2014, The Lancet.

[57]  First response: Race against time , 2014, Nature.

[58]  Michal Rozanski,et al.  Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. , 2014, JAMA.

[59]  I. Grunwald,et al.  Translation of the ‘time is brain’ concept into clinical practice: focus on prehospital stroke management , 2014, International journal of stroke : official journal of the International Stroke Society.

[60]  T. Saifee,et al.  Prehospital thrombolysis in acute stroke: Results of the PHANTOM-S pilot study , 2013, Neurology.

[61]  Klaus Fassbender,et al.  Streamlining of prehospital stroke management: the golden hour , 2013, The Lancet Neurology.

[62]  R. Nogueira,et al.  “Picture to Puncture”: A Novel Time Metric to Enhance Outcomes in Patients Transferred for Endovascular Reperfusion in Acute Ischemic Stroke , 2013, Circulation.

[63]  M. Wintermark,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2013, Stroke.

[64]  Atte Meretoja,et al.  Reducing in-hospital delay to 20 minutes in stroke thrombolysis , 2012, Neurology.

[65]  I. Grunwald,et al.  Mobile stroke unit for diagnosis-based triage of persons with suspected stroke , 2012, Neurology.

[66]  Klaus Fassbender,et al.  Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial , 2012, The Lancet Neurology.

[67]  A. Demchuk,et al.  Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study , 2012, The Lancet Neurology.

[68]  P. Heuschmann,et al.  Development and Validation of a Dispatcher Identification Algorithm for Stroke Emergencies , 2012, Stroke.

[69]  M. Chen,et al.  Transfer Delay Is a Major Factor Limiting the Use of Intra-Arterial Treatment in Acute Ischemic Stroke , 2011, Stroke.

[70]  Yang Liu,et al.  Point‐of‐care laboratory halves door‐to‐therapy‐decision time in acute stroke , 2011, Annals of neurology.

[71]  I. Grunwald,et al.  Bringing the Hospital to the Patient: First Treatment of Stroke Patients at the Emergency Site , 2010, PloS one.

[72]  C. Anderson,et al.  Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2010, Stroke.

[73]  Gregory W Albers,et al.  Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials , 2010, The Lancet.

[74]  Keith Muir,et al.  Thrombolysis with alteplase 3–4·5 h after acute ischaemic stroke (SITS-ISTR): an observational study , 2008, The Lancet.

[75]  H. Adams,et al.  Rural-urban differences in acute stroke management practices: a modifiable disparity. , 2008, Archives of neurology.

[76]  S. Liaw,et al.  Stroke in rural areas and small communities. , 2008, Stroke.

[77]  B. Hatten Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke , 2007 .

[78]  R. Bammer,et al.  Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke , 2007, Stroke.

[79]  J. Gore Lifetime Risk for Stroke , 2006 .

[80]  Michelle Davis,et al.  The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument , 2005, The Lancet Neurology.

[81]  Scott Hamilton,et al.  Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials , 2004, The Lancet.

[82]  Yang Liu,et al.  "Mobile stroke unit" for hyperacute stroke treatment. , 2003, Stroke.

[83]  J. Grotta,et al.  Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. , 2001, JAMA.

[84]  Koroshetz Wj,et al.  Tissue plasminogen activator for acute ischemic stroke. , 1996, The New England journal of medicine.

[85]  E. C. Sherlock,et al.  Emergencies , 2014, From Scalpel to Spade.