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

Abstract

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.

Praxis der präklinischen Schlaganfallversorgung im deutschsprachigen Raum

“…Bezogen auf den direkten Transport zum Thrombektomiezentrum bleibt die Frage offen, inwiefern das Umgehen eines Krankenhauses mit CT eine Diagnosestellung der teilweise ebenfalls zeitkritischen Differenzialdiagnosen intrazerebrale Hämorrhagie oder anderer Schlaganfall-Mimics verzögern. Telemedizinischen Schlaganfallnetzwerke oder alternative Versorgungskonzepte, wie mobile Stroke Units oder mobile Intervention Teams, könnten dazu beitragen, Diagnostik und Therapie des schweren Schlaganfalls zu beschleunigen [ 1 , 10 , 13 , 36 ].…”

We need mobile stroke units

“…hjerneblødning kunne diagnostiseres prehospitalt og transporteres direkte til regionsykehus for spesialisert behandling, som trombektomi eller kirurgi (7). Resultatene er forenlige med internasjonale slagambulansestudier.…”

“…Europeiske retningslinjer basert på analyser av 14 kontrollerte studier (deriblant norske Treat-NASPP) anbefaler nå slagambulanse fremfor standard behandlingsvei for pasienter med mistenkt hjerneslag. De har subanbefalinger for henholdsvis hjerneinfarkt, hjerneblødning og slagimitatorer (pasienter med hjerneslagsymptomer som ender opp med en annen sykehusdiagnose) (7). Sterkest evidens er det for slagambulansehåndtering av hjerneinfarkt.…”

“…Ved storkarokklusjoner, der mekanisk trombektomi ofte er indisert (5), kan slagambulanser også transportere pasientene direkte til et trombektomisenter uten unødvendige forsinkelser (6). Trombolytisk behandling gi i en slagambulanse gir heller ikke økning i komplikasjoner som intrakraniale blødninger (7).…”

Innovative Projekte in der Schlaganfallmedizin

“…In der jüngst erschienenen Leitlinie der European Stroke Organisation wird die Einrichtung von Mobilen Stroke Units zur Verbesserung der prähospitalen Schlaganfallversorgungfalls bezüglich Versorgungsregion möglich und sinnvollempfohlen [48]. Am einfachsten wäre dabei eine biomarkerbasierte Diagnostik in Analogie zur Troponin-T-Diagnostik beim akuten Koronarsyndrom.…”