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Mobile stroke unit use for prehospital stroke treatment—an update

Einsatz einer „Mobilen Stroke Unit“ zur prähospitalen Schlaganfallbehandlung – ein Update

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Abstract

Background

Acute ischemic stroke is a treatable disease. Moreover, there is increasing evidence supporting mechanical recanalization for large-vessel occlusion, even beyond a strict time window. However, only small numbers of patients receive causal treatment.

Methods

One of the main reasons that patients do not receive causal therapy is their late arrival at the correct target hospital, which, depending on the type of stroke, is either a regional stroke unit or a comprehensive stroke center for interventional treatment. In order to triage patients correctly, a fast and complex diagnostic work-up is necessary, allowing a stroke specialist to decide on the best therapy option. As treatment possibilities become more comprehensive with the need for individualized decisions, the gap between treatment options and practical implementation is increasing.

Results

The “mobile stroke unit” concept encompasses the administration of prehospital acute stroke diagnostic work-up, therapy initiation, and triage to the correct hospital using a specially equipped ambulance, staffed with a team specialized in stroke. The concept, which was conceived and first put into practice in Homburg/Saar, Germany, in 2008, is currently spreading with more than 20 active mobile stroke unit centers worldwide. The use of mobile stroke units can reduce the time until stroke treatment by 50% with a tenfold increase of patients treated within the first 60 min of symptom onset.

Conclusion

The mobile stroke unit concept for acute stroke prehospital management is spreading worldwide. Intensive research is still needed to analyze the best setting for prehospital stroke management.

Zusammenfassung

Hintergrund

Ein akuter ischämischer Schlaganfall stellt eine behandelbare Erkrankung dar. Darüber hinaus gibt es zunehmend Belege für die mechanische Rekanalisierung beim Verschluss großer Gefäße, selbst jenseits eines engen Zeitfensters. Allerdings erhält nur eine kleine Anzahl Patienten eine kausale Behandlung.

Methoden

Einer der Hauptgründe dafür, dass Patienten keine kausale Therapie erhalten, ist ihr spätes Eintreffen in einer geeigneten, gezielt ausgewählten Klinik, bei der es sich – je nach Art des Schlaganfalls – entweder um eine regionale Schlaganfallabteilung oder ein übergeordnetes Schlaganfallzentrum für die interventionelle Behandlung handelt. Um eine korrekte Auswahl der Patienten zu treffen, ist eine schnelle und umfassende Diagnostik notwendig, die es einem Schlaganfallspezialisten ermöglicht, über die beste Therapieoption zu entscheiden. Mit zunehmender Komplexität der Therapiemöglichkeiten und der Notwendigkeit individualisierter Entscheidungen wird die Kluft zwischen Therapieoptionen und praktischer Umsetzung größer.

Ergebnisse

Das Konzept der „Mobilen Stroke Unit“ umfasst die Durchführung einer akuten Schlaganfalldiagnostik vor stationärer Aufnahme, des Therapiebeginns und der Auswahl der am besten geeigneten Klinik unter Einsatz eines speziell ausgestatteten Rettungswagens, der mit einem auf Schlaganfall spezialisierten Team besetzt ist. Das Konzept, das 2008 in Homburg/Saar entwickelt und erstmals praktisch umgesetzt wurde, erfährt derzeit bei mehr als 20 aktiven Zentren mit Mobilen Stroke Units eine weltweite Verbreitung. Der Einsatz der Mobilen Stroke Units kann die Zeit bis zur Schlaganfallbehandlung um 50 % reduzieren – mit einem 10-fachen Anstieg der Zahl von innerhalb der ersten 60 min nach Symptombeginn behandelten Patienten.

Schlussfolgerung

Das Konzept der Mobilen Stroke Unit für die Akutversorgung eines Schlaganfalls vor der stationären Aufnahme breitet sich weltweit aus. Intensive Forschung ist weiterhin erforderlich, um die besten Rahmenbedingungen für die bereits vor der stationären Aufnahme erfolgende Schlaganfalltherapie zu untersuchen.

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References

  1. Adeoye O, Hornung R, Khatri P, Kleindorfer D (2011) Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke 42:1952–1955

    Article  CAS  Google Scholar 

  2. Agyeman O, Nedeltchev K, Arnold M et al (2006) Time to admission in acute ischemic stroke and transient ischemic attack. Stroke 37:963–966

    Article  Google Scholar 

  3. Audebert H, Fassbender K, Hussain MS, Ebinger M, Turc G, Uchino K, Davis S, Alexandrov A, Grotta J, PRESTO Group (2017) The PRE-hospital stroke treatment organization. Int J Stroke 12(9):932–940

    Article  Google Scholar 

  4. Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L, Noser E, Persse D, Jackson K, Grotta JC (2015) Benefits of stroke treatment using a mobile stroke unit compared with standard management: the BEST-MSU Study Run-In Phase. Stroke 46(12):3370–3374

    Article  CAS  Google Scholar 

  5. Cerejo R, John S, Buletko AB, Taqui A, Itrat A, Organek N, Cho SM, Sheikhi L, Uchino K, Briggs F, Reimer AP, Winners S, Toth G, Rasmussen P, Hussain MS (2015) A mobile stroke treatment unit for field triage of patients for intraarterial revascularization therapy. J Neuroimaging 25(6):940–945

    Article  Google Scholar 

  6. Gomes JA, Ahrens CL, Hussain MS, Winners S, Rasmussen PA, Uchino K, Cleveland Pre-Hospital Acute Stroke Treatment Study Group (2015) Pre-hospital reversal of warfarin-related coagulopathy in intracerebral hemorrhage in a mobile stroke treatment unit. Stroke 46(5):e118–e120

    Article  Google Scholar 

  7. Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, Kunz A, Koch P, Kellner PA, Gierhake D, Villringer K, Fiebach JB, Grittner U, Hartmann A, Mackert BM, Endres M, Audebert HJ, STEMO Consortium (2014) Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 311(16):1622–1631

    Article  CAS  Google Scholar 

  8. Ebinger M, Kunz A, Wendt M, Rozanski M, Winter B, Waldschmidt C, Weber J, Villringer K, Fiebach JB, Audebert HJ (2015) Effects of golden hour thrombolysis: a Pre-hospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. JAMA Neurol 72(1):25–30

    Article  Google Scholar 

  9. Evenson KR, Foraker RE, Morris DL, Rosamond WD (2009) A comprehensive review of pre-hospital and in-hospital delay times in acute stroke care. Int J Stroke 4:187–199

    Article  CAS  Google Scholar 

  10. Fassbender K, Walter S, Liu Y et al (2003) “Mobile stroke unit” for hyperacute stroke treatment. Stroke 34:e44

    Article  Google Scholar 

  11. Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J (2013) Streamlining of pre-hospital stroke management: the golden hour. Lancet Neurol 12(6):585–596 (Review)

    Article  Google Scholar 

  12. Fassbender K, Grotta JC, Walter S, Grunwald IQ, Ragoschke-Schumm A, Saver JL (2017) Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges. Lancet Neurol 16(3):227–237

    Article  Google Scholar 

  13. Feigin VL, Norrving B, Mensah GA (2017) Global burden of stroke. Circ Res 120(3):439–448

    Article  CAS  Google Scholar 

  14. Hov MR, Nome T, Zakariassen E, Russell D, Røislien J, Lossius HM, Lund CG (2015) Assessment of acute stroke cerebral CT examinations by anaesthesiologists. Acta Anaesthesiol Scand 59(9):1179–1186

    Article  CAS  Google Scholar 

  15. Kim JT, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC, Grau-Sepulveda MV, Hernandez AF, Peterson ED, Schwamm LH, Saver JL (2017) Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5-Hour time-benefit curve in the National United States Get With The Guidelines-Stroke Population. Circulation 135(2):128–139

    Article  CAS  Google Scholar 

  16. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M (2012) Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79(4):306–313

    Article  Google Scholar 

  17. Parker SA, Bowry R, Wu TC, Noser EA, Jackson K, Richardson L, Persse D, Grotta JC (2015) Establishing the first mobile stroke unit in the United States. Stroke 46(5):1384–1391

    Article  CAS  Google Scholar 

  18. Rai AT, Seldon AE, Boo S, Link PS, Domico JR, Tarabishy AR, Lucke-Wold N, Carpenter JS (2017) A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA. J Neurointerv Surg 9(8):722–726

    Article  Google Scholar 

  19. Scholten N, Pfaff H, Lehmann HC, Fink GR, Karbach U (2013) Thrombolysis for acute stroke—a nationwide analysis of regional medical care. Fortschr Neurol Psychiatr 81:579–585

    Article  CAS  Google Scholar 

  20. Schwamm LH, Ali SF, Reeves MJ et al (2013) Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals. Circ Cardiovasc Qual Outcomes 6:543–549

    Article  Google Scholar 

  21. Tong D, Reeves MJ, Hernandez AF et al (2012) Times from symptom onset to hospital arrival in the Get with the Guidelines–Stroke Program 2002 to 2009: temporal trends and implications. Stroke 43:1912–1917

    Article  Google Scholar 

  22. Walter S, Kostopoulos P, Haass A et al (2010) Bringing the hospital to the patient: first treatment of stroke patients at the emergency site. PLoS ONE 5:e13758

    Article  Google Scholar 

  23. Walter S, Kostopoulos P, Haass A et al (2012) Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol 11:397–404

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Saarland University, Kirrbergerstraße 1, 66421, Homburg, Germany

    S. Walter, A. Ragoschke-Schumm, M. Lesmeister, S. A. Helwig & K. Fassbender

  2. Department of Neuroradiology, Saarland University, Homburg, Germany

    M. Kettner

  3. Neuroscience, Faculty of Medicine, Anglia Ruskin University, Chelmsford, UK

    S. Walter & I. Q. Grunwald

Authors
  1. S. Walter
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  2. A. Ragoschke-Schumm
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  3. M. Lesmeister
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  4. S. A. Helwig
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  5. M. Kettner
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  6. I. Q. Grunwald
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  7. K. Fassbender
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Correspondence to S. Walter.

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Conflict of interest

S. Walter, A. Ragoschke-Schumm, M. Lesmeister, S.A. Helwig, M. Kettner, I.Q. Grunwald, and K. Fassbender declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Walter, S., Ragoschke-Schumm, A., Lesmeister, M. et al. Mobile stroke unit use for prehospital stroke treatment—an update. Radiologe 58 (Suppl 1), 24–28 (2018). https://doi.org/10.1007/s00117-018-0408-2

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