Deans' stroke musings: Mobile units provide faster care, better outcomes in acute ischemic stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, February 28, 2022

Mobile units provide faster care, better outcomes in acute ischemic stroke

But still not fast enough to get 100% recovery. Since they are not measuring 100% recovery, they don't give a shit about getting there.

Mobile units provide faster care, better outcomes in acute ischemic stroke

By Robert Herpen, MA

Source/Disclosures

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Compared with standard care, use of mobile units sharply increased the odds of positive outcomes and reduced treatment times for acute ischemic stroke, according to a systematic review and meta-analysis published in JAMA Neurology.

“Safety and effects on shortening time to thrombolysis have been investigated across [mobile stroke unit (MSU)]

implementations in different settings and countries,” Guillaume Turc, MD, of the neurology department at GHU Paris Psychiatrie et Neurosciences, and colleagues wrote. “Although time savings were substantial, it remained unclear whether and to what extent earlier treatment would translate to better clinical outcomes.”

Researchers, seeking to ascertain whether MSU usage is associated with positive outcomes in patients with acute ischemic stroke, searched MEDLINE, Cochrane Library and Embase for studies published between 1960 and 2021 that compared MSU deployment with usual care for patients with suspected stroke. They measured outcomes with the modified Rankin Scale (mRS; excellent = score of 0 to 1 at 90 days; good = score of 0 to 2).

Results showed that MSU use was associated with excellent outcome (adjusted OR = 1.64; 95% CI, 1.27-2.13; five studies; n=3,228), reduced disability over the full range of the mRS (adjusted common OR= 1.39; 95% CI, 1.14-1.70; 3 studies; n=1,563), good outcome (crude OR= 1.25; 95% CI, 1.09-1.44; 6 studies; n=3266), shorter onset to intravenous thrombolysis (IVT) times (median reduction = 31 minutes; 95% CI, 23-29; 13 studies; n = 3,322), delivery of IVT (crude OR = 1.83; 95% CI, 1.58-2.12; 7 studies; n=4,790) and IVT within 60 minutes of symptom onset (crude OR = 7.71; 95% CI, 4.17-14.25; 8 studies; n=3,351).

In addition, data revealed MSU use did not correlate with increased risk for all-cause mortality at 7 days, 90 days or with greater proportions of symptomatic intracranial hemorrhage following IVT.

90-day functional outcomes similar in endovascular thrombectomy regardless of alteplase use
EXTEND-IA TNK: Increased tenecteplase dose does not improve stroke outcomes

“These results should help guideline writing committees and decision makers to shape the future of prehospital stroke care,” Turc and colleagues wrote. “However, MSU implementation is associated with costs and requires optimal integration into regional emergency response services. Further studies will be needed to determine in which local environments the deployment of MSUs would be the most useful.”