Mobile stroke units quicken surgical treatment by 10 minutes

By Christopher Cheney

For stroke patients who undergo intra-arterial thrombectomy (IAT), mobile stroke units generate faster surgical treatment times compared to emergency medical service transport, recent research shows.

“Time is brain” has been a maxim in stroke care for more than a decade. Research published earlier this year indicates brain cell loss during acute ischemic stroke (AIS) ranges from 35,000 cells per minute to more than 27 million cells per minute in “fast progressor” patients.

Intravenous administration of tissue-type plasminogen activator (tPA) and IAT are two of the primary standard-of-care interventions for stroke. IAT is performed mainly at tertiary care hospitals.

In research published recently by Stroke, mobile stroke units (MSU) were associated with a 10-minute gain in a key IAT workflow metric: emergency room arrival to treatment time, or door-to-puncture-time (DTPT). The median DTPT time for MSU patients was 89 minutes compared to 99 minutes for emergency medical services patients.

Several factors contribute to DTPT time rates, including getting patients to the right hospital at the right time, identification of a large vessel occlusion by imaging, and alerting the appropriate teams involved in patient care, the lead author of the Stroke article told HealthLeaders.

“Mobile stroke units can make many of these factors happen more quickly, due to the availability of experts on the mobile stroke unit, the ability to do imaging in the field, and direct communication between the mobile stroke unit and hospital teams,” said Alexandra Czap, MD, a vascular neurology fellow at UTHealth’s McGovern Medical School in Houston.

The 10-minute gain in DPTP time for patients undergoing IAT is significant, she said. “As neurologists, we know that time is brain. Studies show patients can lose up to 27 million brain cells per minute, so we know that every second counts toward helping them preserve brain function.”

MSU care teams can complete several preliminary steps necessary to perform IAT such as computed tomography of the brain, neurologist assessment, tPA eligibility screening, tPA treatment when appropriate, and baseline lab testing. “Several prehospital steps performed in an MSU, including acquisition of clinical history, examination, imaging, and evaluation and administration of tPA are potentially timesaving in IAT triage pathways,” Czap and her coauthors wrote in Stroke.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders