Impact of mobile stroke units

Abstract

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.

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

“…There are increasing numbers of stroke centres worldwide using MSUs to provide acute stroke care to their patients (world map with active centres on https://www.prestomsu.org). 39,40 Reported results indicate an earlier treatment, increased numbers of patients receiving treatment and optimised triage to the individually required level of care. 41–51 Most importantly, some studies have resulted in clinical benefits for patients treated with a MSU rather than conventional stroke care.…”

“…org). 39,40 Reported results indicate an earlier treatment, increased numbers of patients receiving treatment and optimised triage to the individually required level of care. [41][42][43][44][45][46][47][48][49][50][51] Most importantly, some studies have resulted in clinical benefits for patients treated with a MSU rather than conventional stroke care.…”

10th Anniversary of the Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia-Pacific

“…However, similar to the other parts of the world, higher mortality is evident in patients with acute stroke occurring in countries in lower socioeconomic strata with reasons such as lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, lack of availability of thrombolysis and endovascular treatment, insufficient stroke unit beds, and lack of affordability of new interventional therapies [ 24 , 25 ]. As for transportation, the majority of acute stroke patients in Asia still depend on non-EMS, e.g., private cars and public transportation, while on the other hand, mobile stroke units have been implemented in certain areas of India, China, and Thailand [ 26 ].…”

Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation Trial in the Ambulance (Mobile Stroke Unit—TASTE-A): protocol for a prospective randomised, open-label, blinded endpoint, phase II superiority trial of tenecteplase versus alteplase for ischaemic stroke patients presenting within 4.5 hours of symptom onset to the mobile stroke unit

“…With the enhanced access to timely treatments for potential stroke patients via the MSU, 14 there is also the potential to test more effective thrombolytic agents. 15 Alteplase leads to recanalisation of the occluded vessel in only 30%–50% of ischaemic stroke cases, and this rate may be lower with larger more proximal clots causing large vessel occlusion (LVO). Tenecteplase is currently being tested in several large in-hospital trials around the world to identify if it is a more effective stroke thrombolytic therapy than alteplase.…”

“…With the enhanced access to timely treatments for potential stroke patients via the MSU,14 there is also the potential to test more effective thrombolytic agents 15. Alteplase leads to recanalisation of the occluded vessel in only 30%–50% of ischaemic stroke cases, and this rate may be lower with larger more proximal clots causing large vessel occlusion (LVO).…”