Benefits of Stroke Treatment Using a Mobile Stroke Unit Compared With Standard Management

After 1 year of preparation, the nations first Mobile Stroke Unit (MSU) delivering acute stroke treatment with tissue plasminogen activator (tPA) in the prehospital setting was launched in mid 2014. The unit is being operated as part of a clinical trial comparing MSU management to standard management to determine how much faster patients can be treated, how much better patients do if treated in the first hour after symptom onset than if treated later, if the physician on board the MSU can be replaced by a remote physician via telemedicine, and the costs and quality-adjusted life years saved by the MSU approach. We are treating on average over two patients per week with intravenous tPA, with more than 30 % treated within the first hour of symptom onset.

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Abstract TP291: Melbourne Mobile Stroke Unit Increases Stroke Treatment Rates and Treatment Opportunities

Stroke ◽

10.1161/str.50.suppl_1.tp291 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Skye Coote ◽

Henry Zhao ◽

Lauren Pesavento ◽

Francesca Langenberg ◽

Patricia Desmond ◽

...

Keyword(s):

Stroke Unit ◽

Stroke Treatment ◽

Mobile Stroke Unit

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“Mobile Stroke Unit” for Hyperacute Stroke Treatment

Stroke ◽

10.1161/01.str.0000075573.22885.3b ◽

2003 ◽

Vol 34 (6) ◽

Cited By ~ 59

Author(s):

Klaus Fassbender ◽

Silke Walter ◽

Yang Liu ◽

Frank Muehlhauser ◽

Andreas Ragoschke ◽

...

Keyword(s):

Stroke Unit ◽

Stroke Treatment ◽

Hyperacute Stroke ◽

Mobile Stroke Unit

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Air-Mobile Stroke Unit for access to stroke treatment in rural regions

International Journal of Stroke ◽

10.1177/1747493018784450 ◽

2018 ◽

Vol 13 (6) ◽

pp. 568-575 ◽

Cited By ~ 12

Author(s):

Silke Walter ◽

Henry Zhao ◽

Damien Easton ◽

Cees Bil ◽

Jonas Sauer ◽

...

Keyword(s):

Rural Areas ◽

Stroke Unit ◽

Systems Of Care ◽

Intravenous Thrombolysis ◽

Rural And Remote ◽

Stroke Patients ◽

Stroke Treatment ◽

Remote Areas ◽

Mobile Stroke Unit ◽

Rural And Remote Areas

Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites. We describe technical solutions for an Air-Mobile Stroke Unit (Air-MSU) concept, where an aircraft is customized with the ability to perform multimodal computed tomography, in addition to onboard laboratory equipment and telemedicine connection. The Air-MSU is envisioned not only to allow intravenous thrombolysis in the field but also to allow prehospital triage to a comprehensive stroke center through use of contrast intracerebral vascular imaging. Several options for the Air-MSU approach are described, and issues regarding the potential medical benefit, optimal operating environment, technical realization, and integration in pre-existing solutions (e.g., flying doctor service) are addressed. Conclusion The Air-MSU may represent a novel tool to reduce treatment disparity for stroke patients in rural and remote areas. However, this approach requires further implementation research to determine the overall benefit to these communities.

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E-112 A single center comparison of stroke treatment times: impact of a mobile stroke unit

10.1136/neurintsurg-2018-snis.188 ◽

2018 ◽

Author(s):

H Shownkeen ◽

M Mohajer-Esfahani ◽

H Crumlett ◽

A Lindstrom

Keyword(s):

Stroke Unit ◽

Single Center ◽

Stroke Treatment ◽

Mobile Stroke Unit

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Economic evaluation of the Melbourne Mobile Stroke Unit

International Journal of Stroke ◽

10.1177/1747493020929944 ◽

2020 ◽

pp. 174749302092994 ◽

Cited By ~ 1

Author(s):

Joosup Kim ◽

Damien Easton ◽

Henry Zhao ◽

Skye Coote ◽

Garveeta Sookram ◽

...

Keyword(s):

Stroke Unit ◽

Standard Care ◽

Stroke Care ◽

Reperfusion Therapy ◽

Sensitivity Analyses ◽

Local Data ◽

Endovascular Thrombectomy ◽

Stroke Treatment ◽

Mobile Stroke Unit ◽

Life Years

Background The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. Aims To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). Methods The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. Results In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. Conclusions There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.

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Abstract T P200: Feasibility of Telemedicine on a Mobile Stroke Treatment Unit

Stroke ◽

10.1161/str.46.suppl_1.tp200 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Sung Cho ◽

Russell Cejero ◽

Ather Taqui ◽

Ahmed Itrat ◽

Megan M Donohue ◽

...

Keyword(s):

Emergency Department ◽

Ct Scan ◽

Stroke Unit ◽

Registered Nurse ◽

Clinical Care ◽

Control Group ◽

Treatment Unit ◽

Stroke Treatment ◽

Mobile Stroke Unit ◽

Patient Side

Background: Mobile stroke treatment unit (MTSU) with on-site treatment team that includes a stroke physician can provide thrombolysis successfully in pre-hospital setting more quickly than traditional treatment in hospital. We report our initial experience of mobile stroke unit with remote physician presence by telemedicine. Methods: We implemented a MSTU at our institution starting July 18 th , 2014. The unit includes a registered nurse, paramedic, emergency medical personnel, CT technologist. Stroke physician evaluated patient via telemedicine (InTouch RP-Lite) and neuroradioloigst remotely assessed images obtained by Ceretom mobile CT. Data were entered in medical records and a prospective registry. The evaluation and treatment in the first 3 weeks of implementation of MSTU was compared to a control group of patients brought to emergency department (ED) via a traditional ambulance in the preceding 2 months. Times were measured from patient arrival entering the “door” of MSTU or emergency department (ED). Results: Twenty three patients were evaluated by MSTU. All patients were evaluated successfully with CT scan, IV placement, neurologic exam and NIH Stroke scale evaluation over telemedicine, and CT interpretation. Duration of telemedicine evaluation was median 21 minutes (IQR: 17-34 minutes). There was a single 44 second interruption of telemedicine connection that did not affect clinical care. The Median NIHS Stroke Scale was 7 (IQR 2 to 11) and was successfully completed in all 23 patients with assistance of a registered nurse by patient side. The time from door to CT scan completion was similar between MSTU and ED (median 21 minutes and 20 minutes, p=0.70). The time from CT completion to radiologist report to stroke physician was similar between MSTU and ED (median 6 minutes and 4.5 minutes, p=0.18). Conclusion: Mobile stroke unit using telemedicine is feasible and as time efficient as traditional ED evaluation.

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Abstract TP282: Prehospital Acute Stroke Treatment by Critical Care Physicians in a Mobile Stroke Unit

Stroke ◽

10.1161/str.50.suppl_1.tp282 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Karianne Larsen ◽

Lars H Tveit ◽

Henriette S Jæger ◽

Maren R Hov ◽

Jo Røislien ◽

...

Keyword(s):

Critical Care ◽

Acute Stroke ◽

Stroke Unit ◽

Stroke Treatment ◽

Mobile Stroke Unit ◽

Acute Stroke Treatment

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Benefits of stroke treatment delivered using a mobile stroke unit trial

International Journal of Stroke ◽

10.1177/1747493017711950 ◽

2017 ◽

Vol 13 (3) ◽

pp. 321-327 ◽

Cited By ~ 26

Author(s):

Jose-Miguel Yamal ◽

Suja S Rajan ◽

Stephanie A Parker ◽

Asha P Jacob ◽

Michael O Gonzalez ◽

...

Keyword(s):

Ischemic Stroke ◽

Cost Effectiveness ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Healthcare Utilization ◽

Stroke Unit ◽

Standard Management ◽

Mobile Stroke Unit ◽

Tissue Plasminogen

Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.

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