Purpose of Review
To provide a summary of mobile stroke unit (MSU) utilization within Emergency Medicine stroke systems.
MSUs have been deployed around the world into prehospital stroke systems demonstrating the ability to differentiate stroke subtypes and to initiate thrombolysis in eligible patients with shorter symptom onset to treatment times than conventional systems. MSU technology may enable the administration of other standard interventions or future experimental agents in the hyperacute time window. It is conceivable that MSU technology may be extended to other disease states in resource-limited areas without immediate access to an emergency department.
MSUs can identify key stroke subtypes and offer promising reductions in treatment times for the time-sensitive condition of acute ischemic stroke. Further research is necessary to guide optimal utilization within stroke systems.
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Saver JL. Time is brain–quantified. Stroke. 2006;37:263–6.
Miller JB, Heitsch L, Siket MS, Schrock JW, Wira CR 3rd, Lewandowski C, et al. The emergency medicine debate on tPA for stroke: what is best for our patients? Efficacy in the first three hours. Acad Emerg Med. 2015;22(7):852–5.
Goyal M, Jadhav AP, Bonafe A, Diener H, Mendes Pereira V, Levy E, et al. Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: results from the SWIFT PRIME randomized controlled trial. Radiology. 2016;279:888–97.
Adeoye O, Nystrom KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, et al. Recommendations for the establishment of stroke systems of care: a 2019 update: a policy statement from the American Stroke Association. Stroke. 2019;50:e187–210.
Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, et al. Accuracy of prediction instruments for diagnosing large vessel occlusion in individuals with suspected stroke: a systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke. Stroke. 2018;49:e111–22.
Calderon VJ, Kasturiarachi BM, Lin E, Bansal V, Zaidat OO. Review of the mobile stroke unit experience worldwide. Interv Neurol. 2018;7:347–58.
Fassbender K, Walter S, Liu Y, Muehlhauser F, Ragoschke A, Kuehl S, et al. “Mobile stroke unit” for hyper-acute stroke treatment. Stroke. 2003;34:e44.
Zhou H, Coote S, Pesavento L, Langenberg F, et al. The Melbourne Mobile Stroke Unit substantially improves thrombolysis times and pre-hospital triage. J Neurol Neurosurg Psychiatry. 2018;89(6):e5–6.
Parker SA, Bowry R, Wu TC, Noser EA, Jackson K, Richardson L, et al. Establishing the first mobile stroke unit in the United States. Stroke. 2015;46:1384–91.
Cardinal health website https://www.cardinalhealth.com/en/essential-insights/the-emergence-of-mobile-stroke-units.html. Accessed 9/25/19.
Rasmussen P. Stroke management and the impact of mobile stroke treatment units. Cleve Clin J Med. 2015;82(12 suppl 2):S17–21.
Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012;11:397–404.
Weber JE, Ebinger M, Rozanski M, Waldschmidt C, Wendt M, Winter B, et al. Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study. Neurology. 2013;80:163–8.
•• Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA. 2014;311:1622–31 The largest trial to date evaluating the implementation of mobile stroke units demonstrating a reduction in thrombolytic treatment times compared with controls.
Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L, et al. Benefits of stroke treatment using a mobile stroke unit compared with standard management: the BEST-MSU study run-in phase. Stroke. 2015;46:3370–4.
Itrat A, Taqui A, Cerejo R, Briggs F, Cho SM, Organic N, et al. Telemedicine in prehospital stroke evaluation and thrombolysis: taking stroke treatment to the doorstep. JAMA Neurol. 2016;73:162–8.
Taqui A, Cerejo R, Itrat A, Briggs FB, Reimer AP, Winners S, et al. Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology. 2017;88:1305–12.
Helwig SA, Ragoschke-Schumm A, Schwindling L, Kettner M, Roumia S, Kulikovski J, et al. Prehospital stroke management optimized by use of clinical scoring vs mobile stroke unit for triage of patients with stroke a randomized clinical trial. JAMA Neurol. 2019. https://doi.org/10.1001/jamaneurol.2019.2829.
Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE, et al. Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. Lancet Neurol. 2016;15:1035–43.
Tsivgoulis G, Geisler F, Katsanos AH, Korv J, Kunz A, Mikulik R, et al. Ultraearly intravenous thrombolysis for acute ischemic stroke in mobile stroke unit and hospital settings: a comparative analysis. Stroke. 2018;49:1996–9.
Czap AL, Grotta JC, Parker SA, Yamal JM, Bowry R, Sheth SA, et al. Emergency department door-to-puncture time since 2014 observations from the BEST-MSU study. Stroke. 2019;50:1774–80.
•• Yamal JM, Rajan SS, Parker SA, Jacob AP, Gonzolez MO, Gonzoles NR, et al. Benefits of stroke treatment delivered using a mobile stroke unit trial. Int J Stroke. 2018;13(3):321–7 Description of the design of an ongoing multi-centered MSU clinical trial utilizing as its primary outcome measure neurological function.
SGEM Debate on Stroke ambulances, https://thesgem.com/2019/03/sgem-xtra-the-rebel-vs-the-skeptic-smacc-2019/. Accessed 9/26/19.
Rajan SS, Baraniuk S, Parker S, Wu TC, Bowry R, Grotta JC. Implementing a mobile stroke unit program in the United States: why, how, and how much? JAMA Neurol. 2015;72:229–34.
Dietrich M, Silke W, Ragoschke-Schumm A, Helwig S, Levine S, Balucani C, et al. Is prehospital treatment of acute stroke too expensive? An economic evaluation based on the first trial. Cerebrovasc Dis. 2014;38:457–63.
Mathur S, Walter S, Grunwald IQ, Helwig SA, Lesmeister M, Fassbender K. Improving prehospital stroke services in rand underserved settings with mobile stroke units. Front Neurol. 2019;10:e1–11.
Feigin VL, Norrving B. A new paradigm for primary prevention strategy in people with elevated risk of stroke. Int J Stroke. 2014;9:624–6. https://doi.org/10.1111/ijs.12300.
Nogueira RG, Jadhav AP, Haussen DC, Bonofe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.
Austein F, Riedel C, Kerby T, Meyne J, Binder A, Lindner T, et al. Comparison of perfusion CT software to predict the final infarct volume after thrombectomy. Stroke. 2016;47:2311–7.
Grunwald IQ, Ragoschke-Schumm A, Kettner M, Schwindling L, Roumia S, Helwig S, et al. First automated stroke imaging evaluation via electronic Alberta Stroke Program Early CT Score in a mobile stroke unit. Cerebrovasc Dis. 2016;42:332–8.
Bowry R, Parker SA, Yamal JM, Hwang H, Appana S, Rangel-Gutierrez N, et al. Time to decision and treatment with tPA (tissue-type plasminogen activator) using telemedicine versus an onboard neurologist on a mobile stroke unit. Stroke. 2018;49(6):1528–30.
Wu TC, Parker SA, Jagolino A, Yamal JM, Bowry R, Thomas A, et al. Telemedicine can replace the neurologist on a mobile stroke unit. Stroke. 2017;48(2):493–6.
Hov MR, Røislien J, Lindner T, Zakariassen E, Bache KCG, Solyga VM, et al. Stroke severity quantification by critical care physicians in a mobile stroke unit. Eur J Emerg Med. 2019;26(3):194–8.
Hov MR, Zakariassen E, Lindner T, Nome T, Bache KG, Røislien J, et al. Interpretation of brain CT scans in the field by critical care physicians in a mobile stroke unit. J Neuroimaging. 2018;28(1):106–11.
• Hov MR, Ryen A, Finsnes K, Storflor J, Lindner T, Gleditsch. Pre-hospital ct diagnosis of subarachnoid hemorrhage. J Scand J Trauma Resusc Emerg Med. 2017;25(1):21 Publication demonstrating the identification of subarachnoid hemorrhage in an MSU.
Gomes JA, Ahrens CL, Hussain MS, Winners S, Rasmussen PA, Uchino K, et al. Prehospital reversal of warfarin-related coagulopathy in intracerebral hemorrhage in a mobile stroke treatment unit. Stroke. 2015;46:e118–20.
• Rhudy JP, Alexandrov AW, Rike J, Bryndziar T, Hossein ZM, Swatzell V, et al. Geospatial visualization of mobile stroke unit dispatches: a method to optimize service performance. Interv Neurol. 2018;7:464–70 Publication from the Tennessee group discussing how to optimize utilization of a mobile stroke unit within a system of care.
Nagel S, Bouslama M, Krause LU, Küpper C, Messer M, Petersen M, et al. Mechanical thrombectomy in patients with milder strokes and large vessel occlusions. Stroke. 2018;49(10):2391–7.
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Wira, C.R., Aydin, A. Mobile Stroke Units—the Changing Face of Emergency Medicine Stroke Management. Curr Emerg Hosp Med Rep (2020). https://doi.org/10.1007/s40138-020-00207-4
- Acute ischemic stroke
- Mobile stroke unit
- Emergency medical services
- Prehospital stroke treatment
- Stroke emergency mobile