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Mobile Stroke Units: Bringing Treatment to the Patient

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Mobile stroke units (MSUs) have revolutionized emergency stroke care by delivering pre-hospital thrombolysis faster than conventional ambulance transport and in-hospital treatment. This review discusses the history of MSUs technological development, current operations and research, cost-effectiveness, and future directions.

Recent findings

Multiple prospective and retrospective studies have shown that MSUs deliver acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator (IV r-tPA) approximately 30 min faster than conventional care. The 90-day modified Rankin Scores for patients who received IV r-tPA on the MSU compared to conventional care were not statistically different in the PHANTOM-S study. Two German studies suggest that the MSU model is cost-effective by reducing disability and improving adjusted quality-life years post-stroke. The ongoing BEST-MSU trial will be the first multicenter, randomized controlled study that will shed light on MSUs’ impact on long-term neurologic outcomes and cost-effectiveness.

Summary

MSUs are effective in reducing treatment times in acute ischemic stroke without increasing adverse events. MSUs could potentially improve treatment times in large vessel occlusion and intracranial hemorrhage. Further studies are needed to assess functional outcomes and cost-effectiveness. Clinical trials are ongoing internationally.

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Abbreviations

ARTSS-2:

Argatroban r-tPa Stroke Study

ASPECTS:

Alberta Stroke Program Early CT Score

BEST-MSU:

The Benefits of Stroke Treatment Delivered Using a mobile stroke unit

CI:

Confidence interval

CLEAR-ER:

Combined approach to thrombolysis utilizing eptifibatide and recombinant tissue plasminogen activator in acute ischemic stroke enhanced regimen

CT:

Computed tomography

CTA:

Computed tomography angiography

ED:

Emergency department

EMS:

Emergency medical services

FASTEST:

Recombinant Factor VIIa for Acute Hemorrhagic Stroke Administered at Earliest Time

FAST-MAG:

Field Administration of Stroke Therapy-Magnesium

INR:

International normalization ratio

IV:

Intravenous

LVO:

Large vessel occlusion

MOST:

Multi-arm Optimization of Stroke Thrombolysis

mRS:

Modified Rankin Score

MSU:

Mobile stroke unit

NIHSS:

National Institutes of Health Stroke Scale

NPV:

Negative predicative value

NYP:

New York-Presbyterian Hospital

OR:

Odds ratio

PHANTOM-S:

Pre-Hospital Acute Neurological Therapy and Optimization of Medical Care in Stroke Patients Study

PHAST:

The Cleveland Pre-Hospital Acute Stroke Treatment group

POC:

Point of care

PPV:

Positive predicative value

PT:

Prothrombin time

QALYs:

Quality-adjusted life years

ROSIER:

Recognition of Stroke in the Emergency Room

rFVIIa:

Recombinant Factor VIIa

r-tPA:

Recombinant tissue plasminogen activator

SITS-EAST:

Safe Implementation of Treatment in Stroke-East registry

TCD:

Transcranial doppler

US:

United States

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author notes

  1. Mikel S. Ehntholt and Melvin Parasram contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Weill Cornell Medicine, New York, NY, USA

    Mikel S. Ehntholt MD, Melvin Parasram DO, MS, Saad A. Mir MD & Mackenzie P. Lerario MD

  2. New York-Presbyterian Mobile Stroke Treatment Unit Program, New York, NY, USA

    Saad A. Mir MD & Mackenzie P. Lerario MD

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  1. Mikel S. Ehntholt MD
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Ehntholt, M.S., Parasram, M., Mir, S.A. et al. Mobile Stroke Units: Bringing Treatment to the Patient. Curr Treat Options Neurol 22, 5 (2020). https://doi.org/10.1007/s11940-020-0611-0

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