It has been written that 1.9 billion neurons are lost every minute during acute ischemic stroke. The earlier we can intervene, the better, it seems, the outcome would be. However, due to the time necessary for triage, imaging, and evaluation, most patients receive thrombolytics after 2 hours of ictus. In Germany, development of a mobile stroke unit (MSU) has been shown to reduce the median time to tPA delivered. Here, authors describe outcomes of the first MSU developed and initiated in the United States compared to standard management (SM), in a pre-specific, non-randomized run-phase of the BEST-MSU study.
In total, 26 patients were enrolled, with 24 patients enrolled for treatment on the MSU and 2 patients enrolled during the 2 weeks in which patients were treated under SM. On average, 1.5 treatments were given per week on the MSU. Of the 24 MSU patients, 13 patients were tPA eligible of which 12 were treated with tPA. Pertinently, 4 received tPA within 0-60 minutes, 4 within 61-80 minutes, and 4 within 81-270 minutes. The average time from EMS activation by 911 to tPA was 47 minutes while average on scene time from MSU arrival to tPA bolus was 25 minutes, inclusive of laboratory and imaging data obtained on board the MSU.
Observations gleaned from this study are summarized in the full text of the study, but some salient points are that 33% of patients treated with tPA on the MSU were treated within the first hour, with one of the fastest “door to needle times” documented of 25 minutes and a MSU is feasible (although the lack of back up equipment may be an issue) and certainly, enrollment of patients into the study is feasible. In addition, 4 of 24 MSU patients had ICH, and were able to receive early blood pressure management. It is possible that in the future, the MSU could be equipped to deal with not just eraly management of ischemic strokes but also hemorrhagic strokes. Further steps would be possibly the addition of CTA capability to enable routing of patients to comprehensive stroke centers for thrombectomy in the appropriate population, which would further decrease the delay between ictus and treatment.
The goal should actually be prior to hospital, there are enough possibilities out there already just needing more clinical testing that this is not even a BHAG(Big Hairy Audacious Goal) anymore. Maybe the Xprize for the tricorder will do it, no neurologist needed.