Mobile Stroke Unit Speeds Access to Intraarterial Thrombectomy

Pre-emergency department evaluation on a mobile stroke unit (MSU) can speed access to intraarterial thrombectomy (IAT) compared with standard management by emergency medical services (EMS), according to a study published in the July issue of Stroke.

Alexandra L. Czap, M.D., from the University of Texas Health Science Center in Houston, and colleagues compared MSU with standard management by EMS for potential IAT patients. Emergency department door-to-puncture time was compared for all IAT patients, IAT patients post-tissue-type plasminogen activator (tPA) treatment, and IAT patients post-tPA meeting thrombolytic adjudication criteria.

Overall, 161 patients underwent IAT from August 2014 to July 2018: 94 presented to the emergency department via MSU and 67 by EMS. The researchers found that 140 patients received tPA before IAT (85 and 55 in the MSU and EMS arms, respectively), and 126 patients received tPA within thrombolytic adjudication criteria (76 and 50, respectively). MSU patients had shorter door-to-puncture time in minutes than EMS patients (all IAT, 89 versus 99; IAT post-tPA, 93 versus 100; and IAT post-tPA within adjudicated criteria, 93 versus 99.5). Door-to-puncture time decreased at a faster rate for EMS versus MSU-managed patients from 2014 to 2018 and improved by about an hour.

"Prehospital management on an MSU speeds access to IAT once the patient arrives in the emergency department," the authors write. "Opportunity for further acceleration of management should focus on more efficient utilization of MSU capability, transfer of information, and coordination of efforts between prehospital and hospital providers."

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