scholarly journals Bringing Emergency Neurology to Ambulances: Mobile Stroke Unit

2017 ◽  
Vol 38 (06) ◽  
pp. 713-717 ◽  
Author(s):  
Ritvij Bowry ◽  
James Grotta
Keyword(s):  
Clinical Outcomes ◽  
Stroke Unit ◽  
Mechanical Thrombectomy ◽  
Cost Effective ◽  
The United States ◽  
Conclusive Evidence ◽  
Golden Hour ◽  
Intravenous Tissue Plasminogen Activator ◽  
Mobile Stroke Unit ◽  
Emergency Neurology

AbstractIschemic stroke results from blocked arteries in the brain, with earlier thrombolysis with intravenous tissue plasminogen activator (tPA) and/or mechanical thrombectomy resulting in improved clinical outcomes. Mobile Stroke Unit (MSU) can speed up the treatment with tPA and facilitate faster triage for patients to hospitals for mechanical thrombectomy. The first registry-based MSU study in Germany demonstrated faster treatment times with tPA using a MSU, a higher proportion of patients being treated within the first “golden hour,” and a suggestion of improved 3-month clinical outcomes. The first multicenter, prospective, randomized clinical trial comparing MSU versus standard care was started in 2014 after the launch of the MSU in Houston, TX, demonstrating the feasibility and safety of MSU operation in the United States, and reliability of telemedicine to evaluate stroke patients for tPA eligibility. Although conclusive evidence from clinical trials to support MSUs as being cost effective and improving clinical outcomes is still needed, there are a myriad of other clinical and research applications of MSUs that could have profound implications for managing patients with neurological emergencies.

scholarly journals Transdisciplinary Design Aspects of an Air Mobile Stroke Unit

2020 ◽  
Author(s):  
David Chipperfield ◽  
Michael Cheesman ◽  
Cees Bil ◽  
Greg Hanlon
Keyword(s):  
Clinical Outcomes ◽  
Stroke Unit ◽  
Hospital Care ◽  
Rapid Response ◽  
Diagnosis And Treatment ◽  
Ct Scanner ◽  
Golden Hour ◽  
Rural And Urban ◽  
Mobile Stroke Unit ◽  
Time Critical

Stroke is highly treatable but time critical. The greatest opportunity to improve outcomes is in the first ‘Golden Hour’ after onset. Pre-hospital care for stroke in Australia is patchy and poorly coordinated, resulting in gross disparities in clinical outcomes between rural and urban Australians. Clinical outcomes are at least twice as poor for rural Australians compared to their urban counterparts. A proposed solution is an Air MSU, an aircraft configured for rapid response to stroke victims so that diagnosis and treatment can commence onsite. This concept follows the tradition of the Royal Flying Doctors Service who have been providing medical services to rural Australians since 1928. This paper discusses the conflicting medical and aerospace requirements for an aircraft equipped with a CT-scanner including supporting equipment and personnel.

Abstract WP72: Early Experience on Intravenous Tissue Plasminogen Activator Delivery in Mobile Stroke Unit Patients with Stroke Mimics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lila E Sheikhi ◽  
Stacey Winners ◽  
Pravin George ◽  
Andrew Russman ◽  
Zeshaun Khawaja ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Unit ◽  
Early Experience ◽  
Final Diagnosis ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

Implementing a Mobile Stroke Unit Program in the United States

2015 ◽  
Vol 72 (2) ◽  
pp. 229 ◽  
Author(s):  
Suja S. Rajan ◽  
Sarah Baraniuk ◽  
Stephanie Parker ◽  
Tzu-Ching Wu ◽  
Ritvij Bowry ◽  
...  
Keyword(s):  
United States ◽  
Stroke Unit ◽  
The United States ◽  
Mobile Stroke Unit

scholarly journals The Cost Effectiveness of Mobile Stroke Unit in the United States

2020 ◽  
Vol 55 (S1) ◽  
pp. 47-47
Author(s):  
S. Sriudomporn ◽  
R. Rachmad Nugraha ◽  
N. Ahuja ◽  
E. Drabo
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Stroke Unit ◽  
The United States ◽  
Mobile Stroke Unit ◽  
The Cost

Mobile Stroke Units: Current and Future Impact on Stroke Care

2021 ◽  
Vol 41 (01) ◽  
pp. 009-015
Author(s):  
Ritvij Bowry ◽  
James C. Grotta
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Stroke Care ◽  
The United States ◽  
Hospital Treatment ◽  
Additional Time ◽  
Stroke Units ◽  
Require Time ◽  
Intravenous Tissue Plasminogen Activator ◽  
Telemedicine Technology

AbstractIschemic stroke is a leading cause of death and major disability that impacts societies across the world. Earlier thrombolysis of blocked arteries with intravenous tissue plasminogen activator (tPA) and/or endovascular clot extraction is associated with better clinical outcomes. Mobile stroke units (MSU) can deliver faster tPA treatment and rapidly transport stroke patients to centers with endovascular capabilities. Initial MSU trials in Germany indicated more rapid tPA treatment times using MSUs compared with standard emergency room treatment, a higher proportion of patients treated within 60 minutes of stroke onset, and a trend toward better 3-month clinical outcomes with MSU care. In the United States, the first multicenter, randomized clinical trial comparing standard versus MSU treatment began in 2014 in Houston, TX, and has demonstrated feasibility and safety of MSU operations, reliability of telemedicine technology to assess patients for tPA eligibility without additional time delays, and faster door-to-groin puncture times of MSU patients needing endovascular thrombectomy in interim analysis. Scheduled for completion in 2021, this trial will determine the cost-effectiveness and benefit of MSU treatment on clinical outcomes compared with standard ambulance and hospital treatment. Beyond ischemic stroke, MSUs have additional clinical and research applications that can profoundly impact other cohorts of patients who require time-sensitive neurological care.

scholarly journals 011 Melbourne mobile stroke unit halves workflow for acute stroke reperfusion therapy

2019 ◽  
Vol 90 (e7) ◽  
pp. A4.3-A5
Author(s):  
Henry Zhao ◽  
Skye Coote ◽  
Francesca Langenberg ◽  
Damien Easton ◽  
Michael Stephenson ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Reperfusion Therapy ◽  
Ct Scanner ◽  
Royal Melbourne Hospital ◽  
Prehospital Treatment ◽  
Endovascular Thrombectomy ◽  
Prehospital Thrombolysis ◽  
Golden Hour ◽  
Mobile Stroke Unit ◽  
Historical Controls

BackgroundThe Melbourne Mobile Stroke Unit (MSU) utilises a specialised ambulance with on-board CT scanner and multidisciplinary team to provide on-scene imaging, treatment and triage for central Melbourne, Australia. We describe the operational impact of the MSU on commencement of acute reperfusion therapy.MethodsData from the first 12 months of operation were collected for all patients receiving reperfusion therapy from November 2017. Workflow times were compared to contemporary published Australian data and historical controls from Royal Melbourne Hospital.ResultsIn the first calendar 12 months of operation, the Melbourne MSU operated 30.5 service weeks and provided prehospital thrombolysis (tPA) to n=52 patients (44% of eligible infarcts) and directed n=33 patients for endovascular thrombectomy, of which 48% required bypass from the closest non-thrombectomy hospital. The overall median onset-to-tPA for MSU patients was 97.5 mins compared to the Australian metropolitan median of 150 mins. Thrombolysis in the first ‘golden hour’ increased to 13.5% from 3.3% in-hospital. Median onset-to-groin for MSU patients receiving EVT was 162 mins compared to 234 mins from historical controls.DiscussionPrehospital treatment and triage using the Mobile Stroke Unit in metropolitan Melbourne resulted in substantial improvements in commencement of reperfusion therapy. Workflow times are approximately halved for thrombolysis and endovascular thrombectomy respectively. Prehospital thrombolysis also allowed a >400% increase in the proportion of treatment in the first ‘golden hour’.

Mechanical thrombectomy of M1 and M2 middle cerebral artery occlusions

2017 ◽  
Vol 10 (4) ◽  
pp. 330-334 ◽  
Author(s):  
Hisham Salahuddin ◽  
Guru Ramaiah ◽  
Diana E Slawski ◽  
Julie Shawver ◽  
Mark Buehler ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Randomized Clinical Trials ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Current Standard ◽  
Institutional Review ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference

BackgroundOver half of patients who receive intravenous tissue plasminogen activator for middle cerebral artery division (MCA-M2) occlusion do not recanalize, leaving a large percentage of patients who may need mechanical thrombectomy (MT). However, the outcomes of MT for M2 occlusion have not been well characterized.ObjectiveTo determine if MT of M2 occlusion is as safe and efficacious as current standard-of-care MT for M1 occlusions.MethodsWith institutional review board approval, we retrospectively reviewed records of 212 patients undergoing MT for isolated MCA M1 or M2 occlusions during a 36-month period (Sept 2013 to Sept 2016) at two centres. Treatment variables, clinical outcomes, and complications in each group were recorded.ResultsThere were 153 M1 MCA occlusions and 59 M2 MCA occlusions. No statistically significant difference was found in the rate of mortality (20% in M1 vs 13.6% in M2, p=0.32), excellent (34.5% vs 37.3%, p=0.75) or good (51% vs 55.9%, p=0.54) clinical outcomes between the two groups. Infarct volumes (48.4 mL vs 46.2 mL, p=0.62) were comparable between the two groups, as were the rates of hemorrhagic (3.3% vs 3.4%, p=1.0) and procedural complications (3.3% vs 5.1%, p=0.69).ConclusionOur data on MT targeting M2 occlusions demonstrates reasonable safety and functional outcomes. Further randomized clinical trials are needed to clarify which patients may benefit from MT for M2 occlusions.

scholarly journals An economic analysis of a wearable patient sensor for preventing hospital-acquired pressure injuries among the acutely ill patients

2021 ◽  
Author(s):  
Leo Nherera ◽  
Barrett Larson ◽  
Annemari Cooley ◽  
Patrick Reinhard
Keyword(s):  
Cost Saving ◽  
Clinical Outcomes ◽  
Standard Care ◽  
Controlled Trial ◽  
Cost Effective ◽  
The United States ◽  
Patient Treatment ◽  
Decision Analytic Model ◽  
Wearable Sensor ◽  
Hospital Acquired

AbstractMore than 2.5 million people in the United States develop pressure injuries annually, which are one of the most common complications occurring in hospitals. Despite being common, hospital-acquired pressure injuries (HAPIs) are largely considered preventable by regular patient turning. Although current methodologies to prompt on-time repositioning have limited efficacy, a wearable patient sensor has been shown to optimize turning practices and improve clinical outcomes. The purpose of this study was to assess the cost-effectiveness of patient-wearable sensor in the prevention of HAPIs in acutely ill patients when compared to standard practice alone. A decision analytic model was developed to simulate the expected costs and outcomes from the payer’s perspective using data from published literature, including a recently published randomized controlled trial. Both univariate and probabilistic sensitivity analysis were conducted. The patient-wearable sensor was found to be cost saving (dominant). It resulted in better clinical outcomes (77% reduction in HAPIs) compared to standard care and an expected cost savings of $6,621 per patient over a one-year period. Applying the model to a cohort of 1,000 patients, an estimated 203 HAPIs would be avoided with annualized cost reduction of $6,222,884 through all patient treatment settings. The probabilistic analysis returned similar results. In conclusion, the patient-wearable sensor was found to be cost-effective in the prevention of HAPIs and cost-saving to payers and hospitals. These results suggest that patient-wearable sensors should be considered as a cost-effective alternative to standard care in the prevention of HAPIs.

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