Mobile Stroke Units Enable Hyperacute Interventions for Intracerebral Hemorrhage

 Are they fast enough to get 100% recovery? If not; COMPLETE FUCKING FAILURE!

 The only goal in stroke is 100% recovery; if you're not there; GET THE HELL OUT OF STROKE! I take no prisoners in getting stroke solved, so if not following me; GET LOST!

Mobile Stroke Units Enable Hyperacute Interventions for Intracerebral Hemorrhage

Casandra MacLeod, DO, MS https://orcid.org/0009-0002-6918-3274 macleoc@ccf.org, Andrew Zhang, MD https://orcid.org/0000-0002-7801-8310, Nicolas Thompson, MS https://orcid.org/0000-0002-8973-5219, Elham Askari, MD, Merry Huang, MD, Nicholas Koroneos, DO, Maureen Buttrick, BSN, RN, … Show All … , and Jason Mathew, DO https://orcid.org/0000-0002-5862-687XAuthor Info & Affiliations

Stroke

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https://doi.org/10.1161/STROKEAHA.125.053752

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Abstract

BACKGROUND:

Mobile stroke units (MSUs) aim to expedite acute stroke management when compared with conventional emergency medical services (EMS). Despite the growing body of evidence surrounding MSUs and acute ischemic stroke, experience with intracerebral hemorrhage (ICH) in MSUs has been lacking. We aimed to evaluate the impact of MSU transportation, compared with EMS, on times to diagnosis and goal-directed treatment in patients with ICH.

METHODS:

Retrospective analysis of patients with acute ICH triaged by MSU or EMS from January 2018 to December 2022 was performed at 2 tertiary institutions, the Cleveland Clinic (OH) and Stony Brook University (NY). In the EMS cohort, only patients seen between 08:00 and 20:00, corresponding to the operating hours of MSU, were included. Primary outcomes included diagnosis by computed tomography, administration of antihypertensives, and time to goal systolic blood pressure (<160 mm Hg). Analyses included descriptive statistics and multivariable regression modeling of log-transformed time metrics, adjusting for important patient demographic and clinical characteristics.

RESULTS:

Among 540 patients screened with ICH, after removing those with exclusion criteria, 218 MSU patients were compared with 192 EMS patients. Cohorts had similar baseline demographics, majority male (53.7% MSU versus 49.5% EMS), mean age 67±14 and 68±16, respectively. MSUs reduced time to diagnosis by 28% (β=0.72 [95% CI, 0.62–0.82]; P<0.001). Antihypertensives were administered to 78% of MSU patients, whereas not routinely given to EMS-transported patients until emergency department arrival. This facilitated a time reduction of 54% in the administration time of antihypertensive medications in MSU compared with EMS transported patients (β, 0.46 [95% CI, 0.36–0.59]; P<0.001). With 87% of MSU patients achieving blood pressure goal within 1 hour from last known well, compared with 60% in EMS (P<0.001).

CONCLUSIONS:

MSUs provide faster diagnosis and medical treatment for patients with acute ICH than patients transported by conventional EMS.

Graphical Abstract

Transforming stroke care with a mobile stroke unit

Why would you want to do slow CT scans when much faster methods are available?

 The answers are already out there, AND YOU'RE SO FUCKING INCOMPETENT YOU DON'T KNOW THAT!

These people must not have any working brains at all!

Like maybe these fast diagnosis options?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds; February 2017 

Smart Brain-Wave Cap Recognises Stroke Before the Patient Reaches the Hospital

 October 2023

And then this to rule out a bleeder.

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017 

Transforming stroke care with a mobile stroke unit

The quality of stroke care is dependent on decreasing the time from symptom onset to diagnosis and treatment. That is why many providers are turning to Mobile Stroke Units (MSUs) to improve outcomes for their patients. 

MSUs are specialized ambulances equipped with a team of stroke care professionals and advanced technologies like CT imaging, telemedicine, and a point-of-care lab. The 2026 American Heart Association/American Stroke Association Guideline for the Early Management of Patients with Acute Ischemic Stroke now includes recommendations related to the implementation of MSUs.¹

Read on to learn more about the benefits of the MSU care pathway.

For MSU-treated patients, studies have shown:

Lower 90-day mortality rates and better functional outcomes compared to conventional care2

Quicker time to treatment with tPA administered 36 minutes faster than traditional hospital transport3

More than half (53%) of patients made a complete recovery after three months, while only 43% of patients treated by standard ambulance made a full recovery4

Guideline Updated for Early Management of Acute Ischemic Stroke

 REALLY! Useless guidelines; NOT PROTOCOLS!  The stupidity in stroke is going to be hell when they are the 1 in 4 per WHO that has a stroke? Then you just might want 100% recovery and guidelines DO NOT GUARANTEE THAT!

Comeuppance is going to a real bitch for you knowing you could have solved stroke to 100% recovery! Enjoy the rest of your disabled life.

Guideline Updated for Early Management of Acute Ischemic Stroke

Mobile stroke units (MSU) enabled rapid identification and treatment of thrombolytic-eligible patients with acute ischemic stroke and included recommendations relating to MSU implementation.

HealthDay News — In a guideline issued by the American Heart Association/American Stroke Association and published online Jan. 26 in Stroke, updated recommendations are presented for the early management of patients with acute ischemic stroke (AIS)./

Shyam Prabhakaran, M.D., from the University of Chicago, and colleagues updated the guideline for the early management of patients with AIS to replace the 2018 guideline.

The authors note that mobile stroke units (MSU) enable rapid identification and treatment of thrombolytic-eligible patients with AIS and included recommendations relating to MSU implementation. For patients with suspected stroke in the prehospital setting, the guideline endorses consideration of the characteristics of the local system of care and direct transport to the closest endovascular thrombectomy (EVT)-capable hospital. For patients with AIS, intravenous thrombolysis is a mainstay of medical management; the new guideline endorses the use of either alteplase or tenecteplase in the 4.5-hour thrombolytic treatment window. Rapid thrombolytic treatment within the 4.5-hour window is recommended for eligible patients with disabling deficits, regardless of the National Institutes of Health Stroke Scale (NIHSS) score, without advanced imaging selection. The benefit of thrombolysis has not been demonstrated for patients with nondisabling deficits in the 4.5-hour window. EVT has been established as standard treatment for patients with AIS with large vessel occlusion and should be considered in patients previously considered ineligible. For patients with basilar artery occlusion presenting within 24 hours of symptom onset and with an NIHSS score ≥10, EVT is strongly recommended. Recommendations are also included for interventional treatment in pediatric patients with AIS.

“New recommendations in the guideline expand access to cutting-edge treatments, such as clot-removal procedures and medications, simplify imaging requirements so more hospitals can act quickly, and introduce guidance for pediatric stroke for the first time,” Prabhakaran said in a statement.

Several members of the Writing Committee and Peer Review Committee disclosed ties to the biopharmaceutical industry.

Abstract/Full Text

Siemens introduces mobile stroke unit at World Stroke Congress

 I don't know they are getting full recovery of 43% because the only statistics I've seen are 10% full recovery from NINDS and the National Stroke Association.

Siemens introduces mobile stroke unit at World Stroke Congress

Siemens Healthineers presented its Mobile Stroke Unit (MSU) at the pre-Congress Meeting of the 17th World Stroke Congress in Barcelona on October 21.

MSU is the first mobile unit capable of diagnosing and treating stroke at the location where it occurs, according to the firm. Operated by a team of specialized neurology professionals, MSU is a specialized ambulance featuring CT, telemedicine, and a point-of-care lab.

Siemens reported that treatment time with MSU is 36 minutes faster, with more than half of the patients treated with the mobile unit achieving full recovery after three months, compared with 43% with conventional care. The use of MSU also resulted in lower mortality rates at 90 days following a stroke, as well as improved functional outcomes for patients.

Siemens Healthineers also presented its interactive virtual reality tool Time is Brain at the meeting. Time is Brain allows users to experience a simulated cerebrovascular accident firsthand and follow through the phases of its management from different perspectives (such as the patient’s or clinician’s). At the meeting, Time is Brain was set for participants to experience the diagnostic and treatment process through the clinician’s perspective.

Mobile Stroke Unit Reduces Door-to-Puncture Time in LVO-Related Ischemic Stroke

 

But do they get tPA delivered within 3 minutes for full recovery? The goal is 100% recovery; NOT YOUR FUCKING TYRANNY OF LOW EXPECTATIONS of improve outcomes!

In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on survivor requirements of 100% recovery protocols. 

The latest here:

Mobile Stroke Unit Reduces Door-to-Puncture Time in LVO-Related Ischemic Stroke

There are more favorable time metrics for patients transported by mobile stroke unit compared with those transported by EMS. Patients transported by a mobile stroke unit have more favorable time metrics, but have similar outcomes as those transported by emergency medical services (EMS). These findings were published inStroke: Vascular and Interventional Neurology Investigators from Grady Memorial Hospital in the United States hypothesized that patients transported by mobile stroke unit afte occlusion (LVO)-related ischemic stroke(IS) would have faster time metrics when receiving mechanical thrombectomy than patients transported by EMS. This study was a cross-sectional retrospective review of prospectively collected data between 2018 and 2023. Patients (N=565) who received endovascular therapy for LVO-related IS were evaluated for the endpoints of time interval between door-to-imaging, door-to-puncture, and door-to-reperfusion on the basis of whether they arrived at the hospital by mobile stroke unit (n=66) or EMS (n=499). The mobile stroke unit and EMS cohorts comprised 55% and 56% men, they had median ages of 66 (IQR, 47-77) and 66 (IQR, 56-76) years, they had an Alberta Stroke Program Early Computed Tomography (ASPECTS) score of 9 (IQR, 8-10) and 8 (IQR, 7-10), and the most common occlusion locations were middle cerebral artery M1 (39% vs 42%) or M2 (38% vs 23%), respectively. Safety and clinical outcomes were comparable among MSU and EMS-transport groups, supporting the need for further investigation of the direct-to-angio approach for patients with LVO.

Patients who arrived by mobile stroke unit had shorter door-to-imaging (median, 9 vs 17 min;P<.001), -puncture (median, 58 vs 82 min;  P<.001), and -reperfusion (median, 96 vs 127 min; P<.001) than patients who arrived by EMS. In the linear regression analysis, door-to-puncture was significantly shorter with mobile stroke unit than with EMS (b, -23.3; 95% CI, -34.7 to -11.9;P<.001). The significant shortening of time from door-to-puncture with mobile stroke unit was significantly mediated by multimodal imaging (8%;P=.012), time to multimodal imaging completion (53% P<.001), and time to any imaging completion (48%;P<.001). Direct-to-angio was not a significant mediator (P=.132). The mobile stroke unit- and EMS-transported patients did not differ by modified Rankin Scale (mRS) score at discharge (median, 3 vs 3; P=.198), mRS score at 90 days (median, 3 vs 3;P=.455), or mortality at 90 days (23% vs 20%; P=.691).This study was not powered to detect significant differences in clinical outcomes. The study authors concluded, “MSU [mobile stroke unit transport was associated with improved workflow leading to shorter times to treatment. Safety and clinical outcomes were comparable among MSU and EMS-transport groups, supporting the need for further investigation of the direct-to-angio approach for patients with LVO.” This article originally appeared on The Cardiology Advisor

A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.

 Stroke survivors don't care about 'cost'. They want to know 100% RECOVERY EFFECTIVENESS! Are you that blitheringly stupid?

A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.

Peter L van Hulst, Ruben M van de Wijdeven, Esmee Venema, Florentina M E Pinckaers

Neurology. 2025 Aug 12; 105(3):

BACKGROUND AND OBJECTIVES

Mobile stroke units (MSUs) have the potential to improve functional outcome of ischemic stroke patients, through shortening onset-to-treatment times. Previous cost-effectiveness studies have limited generalizability to nonmetropolitan settings and did not evaluate cost-effectiveness over a lifetime horizon. We aimed to develop a regionally adaptable decision-analytic model, to evaluate cost-effectiveness of MSU implementation and to identify the optimal dispatch scenario.

METHODS

We developed a generalizable state-transition microsimulation model with modifiable region-specific parameters and dispatch characteristics to evaluate the lifetime cost-effectiveness from a health care perspective of 1-year MSU implementation. We used the southwest of the Netherlands (1,770,000 inhabitants, 1,592 km², 7 primary stroke centers, 2 thrombectomy-capable stroke centers) as an example. Region-specific input parameters for the model, such as population density, age distribution, and driving times, were obtained at the level of postal codes. We developed a virtual cohort of suspected stroke patients based on age-dependent stroke risks and the number of inhabitants per postal code. We compared the combined dispatch of an MSU and emergency medical services (EMS) with dispatch of EMS alone for patients with onset-to-alarm time <6 hours, living within the catchment area of the MSU. In the base case analysis, the MSU could be dispatched to all postal codes in the study region between 7.00 am and 11.00 pm from a central dispatch site. We assessed the long-term cost-effectiveness through incremental net monetary benefits (iNMBs). Discount rates were 1.5% for effects and 4.0% for costs.

RESULTS

In the base case scenario, the MSU was dispatched to 2,080 of 3,628 patients (57.3%) with a suspected stroke and onset-to-alarm time <6 hours, resulting in a lifetime gain of 399 (95% CI 384-414) additional quality-adjusted life years, €3.9 million (95% CI €3.5 million-€4.3 million) cost savings, and an iNMB of €23.9 million (95% CI €22.8 million-€24.9 million). A smaller catchment area for MSU dispatch was associated with increased cost-effectiveness.

DISCUSSION

Adding an MSU to the dispatch strategy for suspected stroke patients is expected to be cost-effective in our region. Our model facilitates evaluation of the cost-effectiveness of MSU implementation in different regions, settings, and scenarios with varying characteristics.

Source: Neurology

‘A game changer’: Specialized ambulance to improve outcomes for stroke patients could come to Jacksonville

 

But do they get tPA delivered within 3 minutes for full recovery? The goal is 100% recovery; NOT YOUR FUCKING TYRANNY OF LOW EXPECTATIONS of improve outcomes!

In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on survivor requirements of 100% recovery protocols. 

The latest here:

‘A game changer’: Specialized ambulance to improve outcomes for stroke patients could come to Jacksonville

Mobilized Stroke Unit would be partnership between UF Health, JFRD

Specialized ambulance to improve outcomes for stroke patients could come to Jacksonville 44 What Happens When the UF Health Mobile Stroke Treatment Unit is Called? Jacksonville City Council to honor retired WJXT employees who served over 20 years Jacksonville residents can share opinions on ‘Duval DOGE’ at City Hall meeting Tuesday

JACKSONVILLE, Fla. – Earlier this week, a bill was introduced before the Jacksonville City Council which, if passed, would provide over $800,000 for UF Health’s Mobile Stroke Treatment Unit. The specialized ambulance is already operational in Alachua County and is designed to significantly improve outcomes(100% recovery is the goal, NOT THIS! Don't you ever talk to survivors about their goals without pushing them to accept less than full recovery?)  for stroke patients.

RELATED: UF Health-led guidelines call for widespread Type 1 diabetes screening in children

UF Health Shands Hospital, in conjunction with UF Health Jacksonville, wants to launch the second MSTU program in Florida and Duval County. Jacksonville Fire Rescue Chief Keith Powers said when a patient is having a stroke, time is truly of the essence. (Can you get

tPA delivered within 3 minutes for full recovery? NO?  If your goal is not full recovery; I'd have you all fired!)

“What we know from the American Heart Association is every 3 minutes and 14 seconds, somebody in the United States is dying from a stroke,” Powers said. ″When you have a clot, you need to get that perfusion started within that 60-minute time frame.(Way too fucking slow!) And this just allows that to begin a lot quicker."

The MTSU will quickly diagnose patients suffering from a stroke by starting care in the field prior to the patient’s arrival at one of three Comprehensive Stroke Centers in Duval County.

Powers said inside the mobile unit, there will be a 16-slice CT scanner, which will then be used to determine what is happening with the patient. The information collected from the scans will then be transmitted to a neurologist in real time. “There are cameras in the back of the unit that are focused all over, so the neurologist can then tele-medicine in,” Powers said. “It’s like the neurologist is in the back of the unit with the staff members, and he begins to direct treatment on that patient.” The MTSU would be housed at Fire Station 64, located at Harts Road and Dunn Avenue. Chief Powers said JFRD data show it is an area of town with a high number of stroke patients. “It’s one of our underserved communities, but it’s also where the majority of the strokes are happening,” Powers said. “This northwest quadrant of town has got a lot of dots in that area.” Powers said he has visited the MSU in Alachua County and has learned of the impact it is having in that region.

“They told me about a patient that had a stroke that was so debilitating, when they got him in the back of the rescue unit, they had to intubate him, had to put a breathing tube down him because he could not maintain his own airway,” Powers explained. “Under normal circumstances, that patient is probably going to end up in a hospital for a long time, then go to rehab and ended up in a nursing home.”

The chief said in this patient’s case, that quick response and treatment changed everything.

“The next morning, he was extubated, sitting up in bed, asking for pizza, and within two days, he was discharged home with no rehab required because of the work that the unit did in Alachua,” Powers said. “It truly is game changing.”

The bill will fund seven new Jacksonville Fire Rescue Department positions, which will provide advanced life support and ambulance transport services.

It will also fund the lease of the MSTU Rescue vehicle from UF Health for a payment of $1 per year. The agreement will continue for three years and automatically renew for successive terms of one year each unless it’s terminated earlier.

Chief Powers said his hope is for the unit to be operational in May. Ultimately, he hopes to see units in areas throughout Jacksonville, reaching even more patients.

Copyright 2025 by WJXT News4JAX - All rights reserved.

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Prehospital Management in a Mobile Stroke Unit Lowers Post-Stroke Disability

 But did they get tPA delivered within 3 minutes for full recovery? The goal is 100% recovery; NOT YOUR FUCKING TYRANNY OF LOW EXPECTATIONS of less disability!

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? Your patients need an explanation of why you aren't working on survivor requirements of 100% recovery protocols.

Prehospital Management in a Mobile Stroke Unit Lowers Post-Stroke Disability

Patients with ischemic stroke who are potentially eligible for intravenous thrombolysis benefitted from prehospital management in a mobile stroke unit.

Prehospital management in a mobile stroke unit vs standard emergency medical services (EMS) management is associated with more favorable global disability levels(NOT AN ACCEPTABLE GOAL!) at discharge following acute ischemic stroke, according to study findings published in JAMA Neurology.

Researchers conducted a retrospective, observational, cohort study to determine the relationship between prehospital management in a mobile stroke unit vs standard EMS management and global disability at discharge post-acute ischemic stroke. Data were sourced from the American Heart Association’s Get With The Guidelines-Stroke Program. Individuals with an ischemic stroke diagnosis who were potentially eligible for intravenous (IV) thrombolysis who received prehospital management in a mobile stroke unit or standard EMS management between August 2018 and January 2023 were eligible for inclusion. The primary outcome was the level of global disability at discharged, which was measured using the utility-weighted modified Rankin Scale (mRS). Logistic regression and generalized linear mixed models were used in statistical analyses.

A total of 19,433 patients (median age, 73; women, 50.8%; White, 53.5%) with ischemic stroke were included in the study, of whom 1237 (6.4%) received prehospital management in a mobile stroke unit and 18,196 (93.6%) received standard EMS management.

These findings support efforts to expand access to prehospital MSU [mobile stroke unit] management.

Recipients of prehospital management in a mobile stroke unit vs standard EMS management had higher utility-weighted mRS scores (adjusted mean difference [aMD], 0.03; 95% CI, 0.01-0.05), rates of independent ambulation at discharge (adjusted risk ratio [aRR], 1.08; 95% CI, 1.03-1.13), rates of nondisabled outcome at discharge (mRS, 0-1), and functional independence at discharge (mRS, 0-2).

No between-group differences were observed for the following safety endpoints:

• In-hospital mortality: aRR, 1.03; 95% CI, 0.78-1.27;
• In-hospital mortality in combination with discharge to hospice: aRR, 0.99; 95% CI, 0.87-1.15;
• Symptomatic intracranial hemorrhage: aRR, 1.30; 95% CI, 0.94-1.75; and,
• Length of stay: aMD, 0.07; 95% CI, -0.21 to 0.44.

Patients potentially eligible for IV thrombolysis were more likely to receive IV thrombolysis when they received prehospital management in a mobile stroke unit vs standard EMS management (aRR, 1.26; 95% CI, 1.22-1.29).

Among patients diagnosed with ischemic stroke, those who received prehospital management in a mobile stroke unit vs standard EMS management demonstrated a higher utility-weighted mRS score (aMD, 0.04; 95% CI, 0.03-0.05), were more likely to be ambulatory at discharge (aRR, 1.14; 95% CI, 1.11-1.18), and exhibited a lower risk for in-hospital death (aRR, 0.85; 95% CI, 0.71-0.97).

Of patients who were diagnosed with ischemic stroke, hemorrhagic stroke, or no stroke-related diagnosis, those who received prehospital management in a mobile stroke unit vs standard EMS management demonstrated a higher utility-weight mRS (aMD, 0.05l 95% CI, 0.03-0.06).

Study limitations included potential residual confounding, reduced generalizability of results to a more diverse sample population, lack of data regarding the mode of neurologic assessment during prehospital mobile stroke unit management, and conservative bias.

“These findings support efforts to expand access to prehospital MSU [mobile stroke unit] management,” the study authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care

 Why would you need something so slow as an MRI when you already have available these fast options?

TIME IS BRAIN and MRIs take a long time. Depending on the size of the area being scanned and how many images are taken, the whole procedure will take 15 to 90 minutes. 1.9 million neurons die per minute, so why are you letting that many die?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds; February 2017 

Smart Brain-Wave Cap Recognises Stroke Before the Patient Reaches the Hospital

 October 2023

And then this to rule out a bleeder.

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:

Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care

Arvind Kolangarakath

,

Kapil Chalil Madathil

,

Sudeep Hegde

,

Shubham Agrawal

,

Mary Bian

,

Lauren Simmons

, show all

Received 18 Mar 2024, Accepted 06 Jun 2024, Published online: 25 Jun 2024

• Cite this article
• https://doi.org/10.1080/00140139.2024.2367157
• CrossMark

 

   Abstract

This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment.

PRACTITONER SUMMARY

This study investigates the challenges of integrating portable MRI systems into ambulances for faster stroke care. It identifies key barriers such as operational skills, procedural complexities, space constraints, and policy development needs, and offers a few solutions to improve emergency stroke treatment.

Impact of Mobile Stroke Units on Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Prespecified BEST‐MSU Substudy

So, still a failure; you didn't get them to 100% recovery!

Impact of Mobile Stroke Units on Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Prespecified BEST‐MSU Substudy

Alexandra L. Czap,

Anne W. Alexandrov,

May Nour,

Jose‐Miguel Yamal,

Mengxi Wang,

Asha P. Jacob,

Stephanie A. Parker,

Muhammad Bilal Tariq,

Suja S. Rajan,

Andrei V. Alexandrov,

William J. Jones,

… See all authors

Originally published19 Dec 2023https://doi.org/10.1161/SVIN.123.001095Stroke: Vascular and Interventional Neurology. 2024;4:e001095

• Other version(s) of this article

Abstract

Background

The impact of mobile stroke units (MSUs) on outcomes in patients with large vessel occlusions eligible for endovascular thrombectomy (EVT) has yet to be characterized.

Methods

We completed a prespecified substudy of patients with EVT‐eligible stroke with anterior and posterior circulation large vessel occlusions on computed tomography and/or computed tomography angiography who were enrolled in BEST‐MSU (Benefits of Stroke Treatment using a Mobile Stroke Unit). Primary outcome was 90‐day utility‐weighted modified Rankin scale. Groups were compared using chi‐square or Fisher's exact tests for categorical variables, and 2‐sample t‐tests for continuous variables. Multiple logistic regression was used to assess the effect of MSU on binary outcomes after adjusting for other baseline factors.

Results

Of 1515 trial patients, 293 had large vessel occlusions eligible for EVT: 168 in the MSU group and 125 in the emergency medical services group. Baseline characteristics were comparable, with the exception of baseline National Institutes of Health Stroke Scale score (MSU median 19 [interquartile range 13, 23] versus emergency medical services 16 [11, 20], P = 0.002) and study site. The mean (±SD) score on the utility‐weighted modified Rankin scale at 90 days was 0.63±0.39 in MSU group and 0.51±0.41 in emergency medical services group (mean difference 0.13, 95% CI [0.03–0.22]). After adjustment, MSU had significantly higher odds of functional independence (odds ratio 2.60 [95% CI, 1.45–4.77], P = 0.002). Secondary outcomes also favored MSU: early neurologic recovery (30% improvement in National Institutes of Health Stroke Scale score at 24 hours) 68% versus 52%; adjusted odds ratio 1.98 [95% CI, 1.19–3.33]; time of tissue plasminogen activator bolus from symptom onset 65.0 minutes [50.5–92.0] versus 96.0 [79.3–130.0], P≤0.001. The groups had similar onset to arterial puncture (169.0 minutes [133.5, 210.0] versus 162.0 [135.0–207.0], P = 0.83).

Conclusions

In patients with EVT‐eligible(So you're cherry picking candidates rather than having plans to treat all strokes?) large vessel occlusion stroke, MSU management was associated with better clinical outcomes(NOT GOOD ENOUGH! Survivors want 100% recovery! What are your plans to get there?) compared with standard emergency medical services management. MSU management sped thrombolysis but did not expedite EVT treatment times. Future MSU processes should include efforts to capitalize on the potential of MSUs to provide earlier EVT.

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Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

This is the first research I've seen where mobile stroke units had better recovery results than hospital care.  But they don't say exactly what time tPA needs to be delivered to get these results. I'm assuming it's not the 3 minutes that mice need.

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.

The latest here:

Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of a Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

Babak B. Navi MD, MS, RPNI, Ivo Bach MD, Alexandra L. Czap MD, Mengxi Wang PhD, Jose-Miguel Yamal PhD, Asha P. Jacob MD, MPH, Stephanie A. Parker MHA, RN … See all authors

First published: 06 October 2023

https://doi.org/10.1002/ana.26816

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Abstract

Objective

This study was undertaken to examine averted stroke in optimized stroke systems.

Methods

This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue-defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis.

Results

Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue-defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue-defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue-defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue-defined averted stroke and stroke with early symptom resolution.

Interpretation

In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2023

Mobile Stroke Units: The Barriers to Timely tPA Administration in the US

Well your first barrier is delivery in 3 minutes. Bet you can't do that. 

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 

In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery. CAN YOU DO THAT? Since no one can do that, what are the followup procedures that will still deliver 100% recovery?

Don't allow your hospital to use the tyranny of low expectations to drive their goals for stroke recovery. The only goal in stroke is 100% recovery. You may need to scream at your stroke medical 'professionals' to get them to understand that. 

The latest here:

Mobile Stroke Units: The Barriers to Timely tPA Administration in the US

Allison Nguyen

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March 31, 2023

Emergency mobile stroke unit. Ambulance van furnishes services to diagnose stroke patients.

Two neurologists discuss the barriers to timely tPA administration in acute stroke, including the implementation of mobile stroke units.

Stroke is one of the leading causes of death in the United States, with over 795,000 cases yearly. In particular, ischemic strokes have the highest prevalence, constituting 87% of all stroke cases.¹

Early administration of tissue plasminogen activator (tPA) has proven to limit the risk for damage and functional impairment in patients with acute ischemic stroke.^2-4 However, one of the most significant barriers to successful stroke management is administering tPA within the recommended window of 3 hours.⁵

The first mobile stroke unit (MSU) in the US was implemented in 2015 and allowed for earlier tPA administration, leading to significant improvements in functional outcomes for patients with stroke.

Recent pivotal studies, Berlin PRehospital Or Usual Delivery in Stroke Care (B_PROUD; ClinicalTrials.gov Identifier: NCT02869386) and Benefits of Stroke Treatment Delivered by a Mobile Stroke Unit Compared with Standard Management by Emergency Medical Services (BEST-MSU; ClinicalTrials.gov Identifier: NCT02190500), showed significant improvements in 90-day disability scores for patients with acute stroke treated on an MSU compared with emergency medical service (EMS) management in both Germany and the US. The B_PROUD study also showed that the median time from dispatch to initiation of thrombolysis for patients treated with an MSU was 20 minutes shorter than with conventional ambulances. ^6,7(Still way too slow.) 

Essentially everything you need to do for a stroke is in the MSU.

While early studies show promising results for patients treated with MSUs, there are significant barriers to implementing and standardizing these services in the US. Many MSUs have not fully integrated into the existing EMS systems, making it difficult to streamline treatment processes. Additionally, most MSUs operate in densely populated cities. Research has suggested several methods for adapting these services to nonurban settings, such as air ambulances and various transport strategies, but further studies are necessary to prove these concepts.^8,9