Mobile Stroke Units Might Trim Time to Treatment

WEDNESDAY, April 11 (HealthDay News) — Clot-busting drugs can
help stave off lasting disability after a stroke, but they must be given
within a 4.5-hour window and many people arrive at the hospital too late
to use them.

Now, German researchers report that they think they have found a
solution to the problem: mobile stroke units. Equipped with what is needed
to diagnose and treat a stroke, these ambulances are stocked with
clot-busting tissue plasminogen activator (tPA) and the CT scanning
technology needed to confirm whether an ischemic stroke has occurred,
blood flow is blocked and it is safe to use tPA.

Unfortunately, while the mobile stroke units did speed the time to
treatment, this did not lead to improvements in neurological outcomes or
increase the number of people who received tPA. The findings are published
in the April 11 online edition of The Lancet Neurology.

In the study conducted by Dr. Klaus Fassbender and his colleagues from
the University of the Saarland in Homburg, 100 people with suspected
stroke were either treated in the mobile stroke units or at the hospital.
Use of mobile stroke units roughly halved the time from the initial
emergency call to treatment decision, from 76 minutes to 35 minutes.

What’s more, treatment in a mobile stroke unit also lowered the time
from symptom onset to therapy decision to less than an hour for 57 percent
of people. By contrast, just 4 percent who were treated in the hospital
were evaluated in under an hour.

The time from calling emergency services to administering treatment
was 38 minutes among people treated in the mobile unit versus 73 minutes
among those who were treated at the hospital, the investigators found.

Commenting on the study, Dr. Larry Goldstein, director of the Duke
Stroke Center in Durham, N.C., said that while an interesting concept,
mobile stroke units may not be feasible in the United States due to cost.
“There might be some circumstances where such a thing might be considered,
but that would really have to be thought through very carefully.”

Unless and until that occurs, the best way to make sure that people
with suspected stroke get treatment promptly is to have 911 operators
trained to recognize that a caller may be having a stroke and dispatch the
appropriate unit to take them to the nearest stroke center where they can
be evaluated and treated as quickly as possible, Goldstein said.

Dr. Robert Glatter, an emergency medicine physician at Lenox Hill
Hospital in New York City, added that “the concept of a mobile stroke unit
is a promising approach to more rapidly and effectively assess and treat
patients with acute strokes in the field.”

Some potential downsides include the cost of the set-up, Glatter
pointed out. “We will need an adequately powered, larger multi-center
trial to answer the question of whether largely urban-based mobile stroke
units ultimately improve outcome of stroke patients in the ‘time is brain’
paradigm,” he noted.

Glatter agreed that knowing the symptoms of a stroke is the most
important way to make sure that care is delivered in timely fashion.
Stroke symptoms may include facial drooping, difficulty speaking, sudden
numbness, dizziness and confusion.

More information

Is it a stroke? Learn the symptoms at the National Stroke Association.

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