Skip to main content
Top
Published in: Journal of Neurology 9/2021

01-09-2021 | Stroke | Review

A review of mobile stroke units

Author: Jennifer Harris

Published in: Journal of Neurology | Issue 9/2021

Login to get access

Abstract

Purpose of review

Mobile stroke units (MSUs) for prehospital treatment and management of patients with acute stroke have been developed more than a decade ago and is currently spreading worldwide. This review discusses the history of MSU and current operations and research.

Recent findings

Multiple studies have shown that MSU can significantly reduce treatment time with a tenfold increase of patients treated within the first 60 min of symptom onset. Recent preliminary results from the Berlin Prehospital or Usual Delivery of Acute Stroke Care trial (B-PROUD) showed a positive shift in modified Rankin Scale (mRS) scores at 3 months for patients treated in MSUs. Two German studies indicate that the MSU model is cost effective by reducing disability and improving adjusted quality-life years after stroke.

Summary

The MSU model for prehospital management of acute stroke is spreading worldwide. More research is needed, however, to establish cost-effectiveness, efficacy and best setting for prehospital stroke management.
Literature
1.
go back to reference Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC et al (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703CrossRef Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC et al (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375(9727):1695–1703CrossRef
2.
go back to reference Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW et al (2016) Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 316(12):1279–1288CrossRef Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW et al (2016) Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 316(12):1279–1288CrossRef
3.
go back to reference Kim J-T, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC et al (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):128–139CrossRef Kim J-T, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC et al (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):128–139CrossRef
4.
go back to reference Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, SITS-MOST investigators et al (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 369(9558):275–282CrossRef Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, SITS-MOST investigators et al (2007) Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 369(9558):275–282CrossRef
5.
go back to reference Agyeman O, Nedeltchev K, Arnold M, Fischer U, Remonda L, Isenegger J et al (2006) Time to admission in acute ischemic stroke and transient ischemic attack. Stroke 37(4):963–966CrossRef Agyeman O, Nedeltchev K, Arnold M, Fischer U, Remonda L, Isenegger J et al (2006) Time to admission in acute ischemic stroke and transient ischemic attack. Stroke 37(4):963–966CrossRef
6.
go back to reference Evenson KR, Foraker RE, Morris DL, Rosamond WD (2009) A comprehensive review of prehospital and in-hospital delay times in acute stroke care. Int J Stroke 4(3):187–199CrossRef Evenson KR, Foraker RE, Morris DL, Rosamond WD (2009) A comprehensive review of prehospital and in-hospital delay times in acute stroke care. Int J Stroke 4(3):187–199CrossRef
7.
go back to reference Fassbender K, Walter S, Liu Y, Muehlhauser F, Ragoschke A, Kuehl S et al (2003) Mobile stroke unit for hyperacute stroke treatment. The first mobile stroke treatment unit design, concept, and proposal. Stroke 34(6):e44CrossRef Fassbender K, Walter S, Liu Y, Muehlhauser F, Ragoschke A, Kuehl S et al (2003) Mobile stroke unit for hyperacute stroke treatment. The first mobile stroke treatment unit design, concept, and proposal. Stroke 34(6):e44CrossRef
8.
go back to reference Balucani C, Levine SR (2012) The “almost magical” mobile stroke unit revolution. Neurology 78(23):1809–1810CrossRef Balucani C, Levine SR (2012) The “almost magical” mobile stroke unit revolution. Neurology 78(23):1809–1810CrossRef
9.
10.
go back to reference Walter S, Ragoschke-Schumm A, Lesmeister M, Helwig SA, Kettner M, Grunwald IQ et al (2018) Mobile stroke unit use for prehospital stroke treatment: an update. Radiologe 58(1):24–28CrossRef Walter S, Ragoschke-Schumm A, Lesmeister M, Helwig SA, Kettner M, Grunwald IQ et al (2018) Mobile stroke unit use for prehospital stroke treatment: an update. Radiologe 58(1):24–28CrossRef
11.
go back to reference Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T 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(5):397–404CrossRef Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T 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(5):397–404CrossRef
12.
go back to reference Ebinger M, Kunz A, Wendt M, Rozanski M, Winter B, Waldschmidt C et al (2015) Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. JAMA Neurol 72(1):25–30CrossRef Ebinger M, Kunz A, Wendt M, Rozanski M, Winter B, Waldschmidt C et al (2015) Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. JAMA Neurol 72(1):25–30CrossRef
13.
go back to reference Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L et al (2015) Benefits of stroke treatment using a mobile stroke unit compared with standard management: the BEST-MSU study run-in phase. Stroke 46(12):3370–3374CrossRef Bowry R, Parker S, Rajan SS, Yamal JM, Wu TC, Richardson L et al (2015) Benefits of stroke treatment using a mobile stroke unit compared with standard management: the BEST-MSU study run-in phase. Stroke 46(12):3370–3374CrossRef
14.
go back to reference Cerejo R, John S, Buletko AB, Taqui A, Itrat A, Organek N et al (2015) A mobile stroke treatment unit for field triage of patients for intraarterial revascularization therapy. J Neuroimag 25(6):940–945CrossRef Cerejo R, John S, Buletko AB, Taqui A, Itrat A, Organek N et al (2015) A mobile stroke treatment unit for field triage of patients for intraarterial revascularization therapy. J Neuroimag 25(6):940–945CrossRef
15.
go back to reference Audebert H, Fassbender K, Hussain MS, Ebinger M, Turc G, Uchino K, PRESTO Group et al (2017) The PRE-hospital stroke treatment organization. Int J Stroke 12(9):932–940CrossRef Audebert H, Fassbender K, Hussain MS, Ebinger M, Turc G, Uchino K, PRESTO Group et al (2017) The PRE-hospital stroke treatment organization. Int J Stroke 12(9):932–940CrossRef
16.
go back to reference Gyrd-Hansen D, Olsen KR, Bollweg K, Kronborg C, Ebinger M, Audebert HJ (2015) Cost-effectiveness estimate of prehospital thrombolysis: results of the PHANTOM-S study. Neurology 84(11):1090–1097CrossRef Gyrd-Hansen D, Olsen KR, Bollweg K, Kronborg C, Ebinger M, Audebert HJ (2015) Cost-effectiveness estimate of prehospital thrombolysis: results of the PHANTOM-S study. Neurology 84(11):1090–1097CrossRef
17.
go back to reference Bukata R (2017) Are mobile CT stroke units worth the price tag? Emerg Physicians Mon 1:15–18 Bukata R (2017) Are mobile CT stroke units worth the price tag? Emerg Physicians Mon 1:15–18
18.
go back to reference Dietrich M, Walter S, Ragoschke-Schumm A, Helwig S, Levine S, Balucani C et al (2014) Is prehospital treatment of acute stroke too expensive? An economic evaluation based on the first trial. Cerebrovasc Dis 38(6):457–463CrossRef Dietrich M, Walter S, Ragoschke-Schumm A, Helwig S, Levine S, Balucani C et al (2014) Is prehospital treatment of acute stroke too expensive? An economic evaluation based on the first trial. Cerebrovasc Dis 38(6):457–463CrossRef
19.
go back to reference Neumann PJ, Cohen JT (2018) QALYs in 2018—Advantages and concerns. JAMA 319(24):2473–2474CrossRef Neumann PJ, Cohen JT (2018) QALYs in 2018—Advantages and concerns. JAMA 319(24):2473–2474CrossRef
21.
go back to reference Parker SA, Bowry R, Wu TC, Noser EA, Jackson K, Richardson L et al (2015) Establishing the first mobile stroke unit in the United States. Stroke 46(5):1384–1391CrossRef Parker SA, Bowry R, Wu TC, Noser EA, Jackson K, Richardson L et al (2015) Establishing the first mobile stroke unit in the United States. Stroke 46(5):1384–1391CrossRef
22.
go back to reference Schwindling L, Ragoschke-Schumm A, Kettner M, Helwig S, Manitz M, Roumia S et al (2016) Prehospital Imaging-based triage of head trauma with a mobile stroke unit: first evidence and literature review. J Neuroimaging 26(5):489–493CrossRef Schwindling L, Ragoschke-Schumm A, Kettner M, Helwig S, Manitz M, Roumia S et al (2016) Prehospital Imaging-based triage of head trauma with a mobile stroke unit: first evidence and literature review. J Neuroimaging 26(5):489–493CrossRef
23.
go back to reference Garber AM (2004) Cost-effectiveness and evidence evaluation as criteria for coverage policy. Health Aff (Millwood), Suppl Web Exclusives: W4-284-96. Garber AM (2004) Cost-effectiveness and evidence evaluation as criteria for coverage policy. Health Aff (Millwood), Suppl Web Exclusives: W4-284-96.
24.
go back to reference Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE et al (2016) Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. Lancet Neurol 15(10):1035–1043CrossRef Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE et al (2016) Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. Lancet Neurol 15(10):1035–1043CrossRef
25.
go back to reference Nour M, Gornbein, J, Kunz A, Nolte C, Scheitz J, Ebinger M, et al (2019) Magnitude of benefit of prehospital mobile stroke unit vs conventional ED thrombolysis: final estimate based on PHANTOM-S observational registry study. Presented at International Stroke Conference, 2019; Honolulu, HI Nour M, Gornbein, J, Kunz A, Nolte C, Scheitz J, Ebinger M, et al (2019) Magnitude of benefit of prehospital mobile stroke unit vs conventional ED thrombolysis: final estimate based on PHANTOM-S observational registry study. Presented at International Stroke Conference, 2019; Honolulu, HI
26.
go back to reference Audebert HJ (2020) The effects of mobile stroke units on functional outcome after acute cerebral ischemia. Presented at ISC 2020. February 20, 2020. Los Angeles, CA Audebert HJ (2020) The effects of mobile stroke units on functional outcome after acute cerebral ischemia. Presented at ISC 2020. February 20, 2020. Los Angeles, CA
27.
go back to reference Tsivgoulis G, Geisler F, Katsanos AH, Korv J, Kunz A, Mikulik R et al (2018) Ultra-early intravenous thrombolysis for acute ischemic stroke in mobile stroke unit and hospital settings. Stroke 49(8):1996–1999CrossRef Tsivgoulis G, Geisler F, Katsanos AH, Korv J, Kunz A, Mikulik R et al (2018) Ultra-early intravenous thrombolysis for acute ischemic stroke in mobile stroke unit and hospital settings. Stroke 49(8):1996–1999CrossRef
28.
go back to reference Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE et al (2015) Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study. Stroke 46:740–745CrossRef Wendt M, Ebinger M, Kunz A, Rozanski M, Waldschmidt C, Weber JE et al (2015) Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study. Stroke 46:740–745CrossRef
29.
go back to reference Prabhakaran S, Ward E, John S, Lopes DK, Chen M et al (2011) Transfer delay is a major factor limiting the use of intra-arterial treatment in acute ischemic stroke. Stroke 42(6):1626–1630CrossRef Prabhakaran S, Ward E, John S, Lopes DK, Chen M et al (2011) Transfer delay is a major factor limiting the use of intra-arterial treatment in acute ischemic stroke. Stroke 42(6):1626–1630CrossRef
30.
go back to reference Czap AL, Singh N, Bowry R, Jagolino-Cole A, Parker SA, Phan K et al (2020) Mobile stroke unit computed tomography angiography substantially shortens door-to-puncture time. Stroke 51(5):1613–1615CrossRef Czap AL, Singh N, Bowry R, Jagolino-Cole A, Parker SA, Phan K et al (2020) Mobile stroke unit computed tomography angiography substantially shortens door-to-puncture time. Stroke 51(5):1613–1615CrossRef
31.
go back to reference Cox AM, McKevitt C, Rudd AG, Wolfe CD (2006) Socioeconomic status and stroke. Lancet Neurol 5:181–188CrossRef Cox AM, McKevitt C, Rudd AG, Wolfe CD (2006) Socioeconomic status and stroke. Lancet Neurol 5:181–188CrossRef
32.
go back to reference Teuschl Y, Brainin M (2010) Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke 5:187–208CrossRef Teuschl Y, Brainin M (2010) Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke 5:187–208CrossRef
33.
go back to reference Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M et al (2013) Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals? Stroke 44:2848–2853CrossRef Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M et al (2013) Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals? Stroke 44:2848–2853CrossRef
34.
go back to reference Newbury J, Kleinig T, Leyden J, Arima H, Castle S, Cranefield J et al (2017) Stroke epidemiology in an Australian rural cohort (SEARCH). Int J Stroke 12:161–168CrossRef Newbury J, Kleinig T, Leyden J, Arima H, Castle S, Cranefield J et al (2017) Stroke epidemiology in an Australian rural cohort (SEARCH). Int J Stroke 12:161–168CrossRef
35.
go back to reference Koifman J, Hall R, Li S, Stamplecoski M, Fang J, Saltman AP et al (2016) The association between rural residence and stroke care and outcomes. J Neurol Sci 15(363):16–20CrossRef Koifman J, Hall R, Li S, Stamplecoski M, Fang J, Saltman AP et al (2016) The association between rural residence and stroke care and outcomes. J Neurol Sci 15(363):16–20CrossRef
36.
go back to reference Shuaib A, Jeerakathil T (2018) Alberta mobile stroke unit I. The mobile stroke unit and management of acute stroke in rural settings. CMAJ 190:E855–858CrossRef Shuaib A, Jeerakathil T (2018) Alberta mobile stroke unit I. The mobile stroke unit and management of acute stroke in rural settings. CMAJ 190:E855–858CrossRef
37.
go back to reference Walter S, Zhao H, Easton D, Bil C, Sauer J, Liu Y et al (2018) Air-mobile stroke unit for access to stroke treatment in rural regions. Int J Stroke 13:568–575CrossRef Walter S, Zhao H, Easton D, Bil C, Sauer J, Liu Y et al (2018) Air-mobile stroke unit for access to stroke treatment in rural regions. Int J Stroke 13:568–575CrossRef
38.
go back to reference Kummer B, Lerario M, Hunter M, Efraim E, Wu X, Omran S, et al. (2019) Geographic analysis of mobile stroke unit treatment in a densely populated urban area: The New York city METRONOME registry. Presented at International Stroke Conference, 2019; Honolulu, HI Kummer B, Lerario M, Hunter M, Efraim E, Wu X, Omran S, et al. (2019) Geographic analysis of mobile stroke unit treatment in a densely populated urban area: The New York city METRONOME registry. Presented at International Stroke Conference, 2019; Honolulu, HI
39.
go back to reference Lahr MM, van der Zee DJ, Vroomen PC, Luijckx GJ, Buskens E (2013) Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals. PLoS ONE 8(11):e79049CrossRef Lahr MM, van der Zee DJ, Vroomen PC, Luijckx GJ, Buskens E (2013) Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals. PLoS ONE 8(11):e79049CrossRef
Metadata
Title
A review of mobile stroke units
Author
Jennifer Harris
Publication date
01-09-2021
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 9/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-09910-4

Other articles of this Issue 9/2021

Journal of Neurology 9/2021 Go to the issue