Use of mobile stroke units in Germany sped time to treatment and reduced disability after stroke compared with standard of care transport. In the prospective clinical trial B_PROUD (NCT03931616), time to treatment and outcomes for individuals with acute ischemic stroke (AIS) who transport with imaging and treatment in a mobile stroke unit were compared to those of individuals who had transport only in a conventional ambulance. Whether or not a person had transport in a mobile stroke unit vs a conventional ambulance was based upon the availability of a mobile stroke unit.
Those who had transport and treatment in a mobile stroke unit received a tissue plasminogen activator (tPA) for thrombolysis 20 minutes earlier and had a 26% reduction in likelihood and severity of disability 3 months after their stroke.
A total of 749 individuals, average age 73 and 54% male with ischemic stroke, had transport, imaging, and treatment in a mobile stroke unit. A total of 794 individuals with ischemic stroke, average age 74 and 52% male, had transport only in a conventional ambulance. All individuals had in-hospital treatment after transport.
In Germany, mobile stroke units are staffed with emergency medicine neurologist and equipped with CT scanners and laboratory capabilities. Treatment in the mobile stroke unit consisted of administration of the tPA alteplase.
“While we had anticipated better outcomes (with treatment) in the mobile stroke units, we are amazed by the magnitude of the effects,” said lead study author Heinrich Audebert, MD, professor in the Department of Neurology and Center for Stroke Research at Charité Universitätsmedizin in Berlin. “It is obvious that clot-busting treatment is most effective if it is applied in the ultra-early phase of stroke – ideally within the first or ‘golden hour’ of symptom onset. Stroke treatment is more effective the earlier it starts,” he said. “Just waiting until the patient arrives at the hospital is not enough anymore.”
These results were presented at the International Stroke Conference in Los Angeles, CA February 19-21, 2020.
Lee I. Kubersky, MD
Rashmi B. Halker Singh, MD, FAHS, FAAN
Britany Klenofsky, MD, and Huma U. Sheikh, MD