Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin

Abstract

for the Berlin_PRehospital Or Usual Delivery in stroke care (B_PROUD) study group IMPORTANCE Effects of thrombolysis in acute ischemic stroke are time-dependent. Ambulances that can administer thrombolysis (mobile stroke units [MSUs]) before arriving at the hospital have been shown to reduce time to treatment. OBJECTIVE To determine whether dispatch of MSUs is associated with better clinical outcomes for patients with acute ischemic stroke. DESIGN, SETTING, AND PARTICIPANTSThis prospective, nonrandomized, controlled intervention study was conducted in Berlin, Germany, from February 1, 2017, to October 30, 2019. If an emergency call prompted suspicion of stroke, both a conventional ambulance and an MSU, when available, were dispatched. Functional outcomes of patients with final diagnosis of acute cerebral ischemia who were eligible for thrombolysis or thrombectomy were compared based on the initial dispatch (both MSU and conventional ambulance or conventional ambulance only).EXPOSURE Simultaneous dispatch of an MSU (computed tomographic scanning with or without angiography, point-of-care laboratory testing, and thrombolysis capabilities on board) and a conventional ambulance (n = 749) vs conventional ambulance alone (n = 794). MAIN OUTCOMES AND MEASURESThe primary outcome was the distribution of modified Rankin Scale (mRS) scores (a disability score ranging from 0, no neurological deficits, to 6, death) at 3 months. The coprimary outcome was a 3-tier disability scale at 3 months (none to moderate disability; severe disability; death) with tier assignment based on mRS scores if available or place of residence if mRS scores were not available. Common odds ratios (ORs) were used to quantify the association between exposure and outcome; values less than 1.00 indicated a favorable shift in the mRS distribution and lower odds of higher levels of disability. RESULTSOf the 1543 patients (mean age, 74 years; 723 women [47%]) included in the adjusted primary analysis, 1337 (87%) had available mRS scores (primary outcome) and 1506 patients (98%) had available the 3-tier disability scale assessment (coprimary outcome). Patients with an MSU dispatched had lower median mRS scores at month 3 (1; interquartile range [IQR], 0-3) than did patients without an MSU dispatched (2; IQR, 0-3; common OR for worse mRS, 0.71; 95% CI, 0.58-0.86; P < .001). Similarly, patients with an MSU dispatched had lower 3-month coprimary disability scores: 586 patients (80.3%) had none to moderate disability; 92 (12.6%) had severe disability; and 52 (7.1%) had died vs patients without an MSU dispatched: 605 (78.0%) had none to moderate disability; 103 (13.3%) had severe disability; and 68 (8.8%) had died (common OR for worse functional outcome, 0.73, 95% CI, 0.54-0.99; P = .04). CONCLUSIONS AND RELEVANCEIn this prospective, nonrandomized, controlled intervention study of patients with acute ischemic stroke in Berlin, Germany, the dispatch of mobile stroke units, compared with conventional ambulances alone, was significantly associated with lower global ...

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

“…[25][26][27] A recent report demonstrated improved outcomes but with only 13 min faster onset to puncture. 28 Moreover, DAS will lead to patients being taken for catheter arteriography who do not have LVO and requires an angiography room and team to be rapidly available, which may not be possible in many hospitals.…”

Use of Portable Imaging Modalities in Patients With Neurologic Disorders: A Case-Based Discussion

“…The advent of these portable imaging devices also allows for revolutionary change in the management of emergency neurologic care. Many hospitals have started to use mobile stroke unit which can contain a CT scanner in the ambulance [10][11][12]. This allows for earlier administration of thrombolytics by allowing for providers to rule out the presence of hemorrhage en route to the hospital.…”

“…This allows for earlier administration of thrombolytics by allowing for providers to rule out the presence of hemorrhage en route to the hospital. Data from these mobile stroke units can further guide patients to either a primary stroke center or a comprehensive stroke center based on the need for further diagnostic work-up and treatment [10][11][12].…”

Stroke care equity in rural and remote areas - novel strategies

“…Randomised studies have shown that MSU-based stroke management can reduce the time to treatment and substantially increase the number of treated patients. More importantly, golden hour thrombolysis, namely treatment within the first 60 min after symptom onset, with highest chances of full recovery, is far more commonly achieved in the MSU group compared to the control group [25][26][27] . Indeed, a recent prospective interventional study (B-Proud) with acute ischaemic stroke patients showed that the dispatch of a MSU was significantly associated with a better clinical outcome as assessed with the modified Ranking score after 90 days [28] .…”