Comparison of Mobile Stroke Unit With Usual Care for Acute Ischemic Stroke Management

Turc, Guillaume; Hadziahmetovic, Melika; Walter, Silke; Чурилов, Леонид; Larsen, Karianne; Grotta, James C.; Yamal, José‐Miguel; Bowry, Ritvij; Katsanos, Aristeidis H.; Zhao, Henry; Donnan, Geoffrey A; Davis, Stephen M.; Hussain, Muhammad Shazam; Uchino, Ken; Helwig, Stefan A.; Johns, Hannah; Weber, Joachim E.; Nolte, Christian H.; Kunz, Alexander; Steiner, Thorsten; Sacco, Simona; Ebinger, Martin; Tsivgoulis, Georgios; Faßbender, Klaus; Audebert, Heinrich J.

doi:10.1001/jamaneurol.2021.5321

Cited by 48 publications

(44 citation statements)

References 65 publications

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“…In case of unavailable or unclear data due to partially overlapping sets of participants, the corresponding authors of relevant studies were contacted to obtain unpublished, disentangled results collected but not reported in the original publication. 52 This was incorporated in the present analyses.5. Six MWG members (SW, HA, KL, TS, SS and G.Turc) independently screened the titles and abstracts of the publications identified by the electronic search and assessed the full text of potentially relevant randomised and non-randomised studies.6.…”

Section: Methodsmentioning

confidence: 99%

Section: The Recommendation Was Based On a Systematicmentioning

confidence: 99%

“…[41][42][43][44][45][46][47][48][49][50][51] Most importantly, some studies have resulted in clinical benefits for patients treated with a MSU rather than conventional stroke care. 49,50,52 In view of the former considerations and to address the current knowledge gap on this topic, we set out to provide the first guideline on the use of MSUs for stroke care. The current guideline aims to provide recommendations about whether MSU ambulances are of advantage for prehospital stroke management and to facilitate decision-making when considering MSU implementation as a service improvement.…”

Section: Introductionmentioning

confidence: 99%

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European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Walter

Audebert

Katsanos

et al. 2022

European Stroke Journal

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The safety and efficacy of mobile stroke units (MSUs) in prehospital stroke management has recently been investigated in different clinical studies. MSUs are ambulances equipped with a CT scanner, point-of-care lab, telemedicine and are staffed with a stroke specialised medical team. This European Stroke Organisation (ESO) guideline provides an up-to-date evidence-based recommendation to assist decision-makers in their choice on using MSUs for prehospital management of suspected stroke, which includes patients with acute ischaemic stroke (AIS), intracranial haemorrhage (ICH) and stroke mimics. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and aggregated data meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements are provided where sufficient evidence was not available to provide recommendations based on the GRADE approach. We found moderate evidence for suggesting MSU management for patients with suspected stroke. The patient group diagnosed with AIS shows an improvement of functional outcomes at 90 days, reduced onset to treatment times and increased proportion receiving IVT within 60 min from onset. MSU management might be beneficial for patients with ICH as MSU management was associated with a higher proportion of ICH patients being primarily transported to tertiary care stroke centres. No safety concerns (all-cause mortality, proportion of stroke mimics treated with IVT, symptomatic intracranial bleeding and major extracranial bleeding) could be identified for all patients managed with a MSU compared to conventional care. We suggest MSU management to improve prehospital management of suspected stroke patients.

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Section: Methodsmentioning

confidence: 99%

Section: The Recommendation Was Based On a Systematicmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Walter

Audebert

Katsanos

et al. 2022

European Stroke Journal

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“…Following a small randomized controlled trial, results from only 2 large nonrandomized clinical studies of MSU dispatch (B_PROUD primary population and BEST-MSU) with blinded outcome assessment investigating 90-day mRS have been published; [3][4][5] both studies focused only on patients eligible for reperfusion treatments. The BEST-MSU reported a post-hoc secondary analysis, which found a favorable effect of MSU on mRS at hospital discharge among all patients regardless of treatment eligibility.…”

Section: Discussionmentioning

confidence: 99%

Effect of Mobile Stroke Unit Dispatch in all Patients with Acute Stroke or TIA

Rohmann

Piccininni

Ebinger

et al. 2022

Annals of Neurology

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Objective: To determine the effect of additional mobile stroke unit (MSU) dispatch on functional outcomes among the full spectrum of stroke patients, regardless of subtype or potential contraindications to reperfusion therapies. Methods: We used data from the nonrandomized Berlin-based B_PROUD study (02/2017 to 05/2019), in which MSUs were dispatched based solely on availability, and the linked B-SPATIAL stroke registry. All patients with final stroke or transient ischemic attack (TIA) diagnoses were eligible. The intervention under study was the additional dispatch of an MSU, an emergency physician-staffed ambulance equipped to provide prehospital imaging and thrombolytic treatment, compared to conventional ambulance alone. The primary outcome was the 3-month modified Rankin Scale (mRS) score, and the co-primary outcome was a 3-tiered disability scale. We identified confounders using directed acyclic graphs and obtained adjusted effect estimates using inverse probability of treatment weighting. Results: MSUs were dispatched to 1,125 patients (mean age: 74 years, 46.5% female), while for 1,141 patients only conventional ambulances were dispatched (75 years, 49.9% female). After confounding adjustment, MSU dispatch was associated with more favorable 3-month mRS scores (common odds ratio [cOR] = 0.82; 95% confidence interval [CI]: 0.71-0.94). No statistically significant association was found with the co-primary outcome (cOR = 0.86; 9% CI: 0.72-1.01) or 7-day mortality (OR = 0.94; 95% CI: 0.59-1.48). Interpretation: When considering the entire population of stroke/TIA patients, MSU dispatch improved 3-month functional outcomes without evidence of compromised safety. Our results are relevant for decision-makers since stroke subtype and treatment eligibility are unknown at time of dispatch.

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“…Allerdings war dies aufgrund der dann längeren Prozesszeiten im Rettungsdienst mit vergleichsweise geringen Auswirkungen auf die Zeit von Symptom-bis Lysebeginn verbunden [39,40]. In den mittlerweile zahlreichen Studien verschiedener MSU-Projekte zeigt sich konsistent eine Verkürzung der Alarmierung-bis-Therapie-Zeiten von 20 bis 40 Minuten [42]. In den inzwischen vorliegenden großen prospektiven Outcome-Studien in Deutschland und den Vereinigten Staaten zeigte sich im Vergleich zur konventionellen Rettungsdienstversorgung eine deutliche Reduktion von Behinderung und Tod bei Patient*innen mit einem ischämischen Schlaganfall, die mit einer MSU versorgt wurden [43,44].…”

Section: Mobile Stroke Unitsunclassified

Innovative Projekte in der Schlaganfallmedizin

Audebert¹

2022

Notfallmedizin up2date

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Bei Einbeziehung neurologischer Fachexpertise werden durch das TeleNotarztsystem eine verbesserte Erkennung eines Schlaganfallereignisses und Triage ermöglicht. Durch eine Vorverlegung der Schlaganfalldiagnostik und der Thrombolyse bereits an den Notfallort verbessern mobile Stroke Units mit integriertem Computertomografen die Prognose von Patient*innen mit einem ischämischen Schlaganfall ( Abb. 1 ). Technische Weiterentwicklungen eröffnen in der Zukunft möglicherweise die Perspektive, die spezifische Schlaganfallbehandlung auch auf normale Rettungswagen vorzuverlagern.

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Comparison of Mobile Stroke Unit With Usual Care for Acute Ischemic Stroke Management

Cited by 48 publications

References 65 publications

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

Effect of Mobile Stroke Unit Dispatch in all Patients with Acute Stroke or TIA

Innovative Projekte in der Schlaganfallmedizin

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