According to the study, which was recently presented at the American Stroke Association’s International Stroke Conference, stroke patients treated in mobile stroke units received a lifesaving clot-busting medication called tissue plasminogen activator (tPA), or alteplase, more frequently and sooner than patients who received emergency care from a standard ambulance. “The whole idea of the mobile stroke unit is to take the emergency room to the patient. It’s essentially a stroke center on wheels,” says James C. Grotta, MD, the lead study author and the director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann Texas Medical Center in Houston. He adds that “tPA is the only approved drug for stroke. It’s given in the emergency room and has been shown to be effective.” Individuals transported by a mobile stroke unit were less likely to have disability from stroke compared with those brought to the emergency department by a standard ambulance.
Time Is Brain When It Comes to Stroke Treatment
The researchers examined data from 1,047 patients who had an ischemic stroke and were treated at seven medical centers throughout the United States between 2014 and 2020, including Houston; New York City; Los Angeles; Memphis; Aurora, Colorado; Indianapolis; and Burlingame, California. In all, 617 patients were treated via mobile stroke units and 430 received standard ambulance emergency care. The results showed that overall, 97 percent of patients treated in a mobile stroke unit received tPA, compared with 80 percent of those transported to the hospital by a standard ambulance. About a third of stroke patients brought to the emergency department via a mobile stroke unit were treated within the first hour after the onset of symptoms. Only 3 percent of patients transported by a standard ambulance received treatment within this time frame. “Within the first hour, the clot is more porous and there’s also been less damage to the brain,” Dr. Grotta says. “Although there’s not a lot of data on patients treated within the first hour, our hypothesis is that patients treated in the first hour will have a much better response to treatment.” In this study, that hypothesis proved correct. More than half of stroke patients treated by a mobile stroke unit made a complete recovery after three months, compared with 43 percent treated by emergency care in a standard ambulance. May Nour, MD, PhD, another author of the study and the medical director of the University of California in Los Angeles mobile stroke unit program, adds, “[The] study demonstrated that out of 100 patients treated earlier on mobile stroke units, rather than later in the emergency department, 27 had less severe disability, of whom 11 will be disability-free.”
FAST Can Help You Recognize the Signs of Stroke
Stroke is a leading cause of death in the United States and a major cause of disability. According to the Centers for Disease Control and Prevention (CDC), about 795,000 people across the country have a stroke each year. Getting treatment fast is important for preventing disability or death from a stroke. “Stroke is a time-sensitive emergency condition,” Dr. Nour says. “Earlier conclusive diagnosis and treatment is needed for patients to have the greatest potential for favorable outcome and recovery.” Recognizing the first symptoms of a stroke and knowing when to call 911 can help save lives. The acronym FAST is an easy way to remember the sudden signs of a stroke.
Face drooping Does one side of the face feel numb? Ask the person to smile to see if one side droops.Arm weakness Is one arm weak or numb? Ask the person to raise both arms to see if one drifts downward.Speech difficulty Is speech slurred? Ask the person to repeat a simple sentence.Time to call 911 If the person shows any of these symptoms, even if they go away, call 911 immediately.
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The Future of Stroke Care
Currently, there are 20 mobile stroke unit sites throughout the United States. The authors hope their research will lead to these units being more widely used. “Our results show that if mobile stroke units were widely deployed, they could have a major public health impact on stroke outcomes,” Grotta says. For that to happen, insurers would need to reimburse for the cost of mobile stroke units. “Right now, there’s no additional reimbursement beyond what a regular ambulance collects for a mobile stroke unit, but it costs more to keep it in operation,” Grotta says. While the initial data released from this study looked at 90-day outcomes, the researchers will continue to follow patients for a full year. “This will allow us to measure how much downstream benefit there is — how many fewer days of rehab, how many fewer images, how many fewer days in the hospital — so we can put a number on the long-term cost reduction,” Grotta says. “Presumably, insurers will see that mobile stroke units improve outcomes and therefore save money to the healthcare system and will be willing to reimburse more,” he continued. For her part, Nour says she believes mobile stroke units “should be the standard for prehospital care for stroke patients.” She anticipates a greater drive for the initiation of new mobile stroke units, not only nationally, but around the world. “My dream is to see a fleet of mobile stroke units giving rapid, emergency, prehospital stroke care to every Los Angeleno at risk,” Nour says. “It’s our duty to stroke victors (survivors) across our county to advocate for them and for their meaningful recovery.”
