Abstract TP282: Prehospital Acute Stroke Treatment by Critical Care Physicians in a Mobile Stroke Unit

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Background: Mobile Stroke Units (MSU) diagnose and treat stroke prehospitally to reduce time from symptom onset-to-treatment (OTT). Several MSU-models exist world wide, but the best framework for MSUs are still unknown. Many models depend on in-hospital personnel working in the prehospital field. The MSU in Treat-NASPP (Norwegian Acute Stroke Prehospital Project) mimics the Norwegian Helicopter Emergency Medical Services and adds diagnostics and treatment of acute stroke to the existing prehospital emergency system. Objective: To investigate if the Treat-NASPP MSU-model is timesaving and safe. Methods: Treat-NASPP started 15th of May 2017 and is an ongoing, prospective, controlled intervention study. The inclusion criteria are: age over 18 years, not pregnant and clinical stroke symptoms with onset within the last 4 hours. The MSU is manned with an anesthesiologist trained in prehospital critical care, a nurse and a paramedic, and it is active 8 a.m. to 8 p.m. on weekdays 2 weeks per month. The control group is dispatch with ordinary ambulance and in-hospital treatment. The emergency medical communication center dispatches the MSU and/or ordinary ambulance whenever acute stroke is suspected. Results: By 1st of July 2018, 74 patients are included in the study. In the intervention group (N=49) 23 (46%) received thrombolysis, and in the control group (N=25), 10 (40%) received thrombolysis. Median (quartiles) OTT time was 98 minutes (72-184) in the MSU-group and 120,5 (107-169) in the control group, p=0,211. Median (quartiles) emergency call-to-treatment time was 29,5 minutes shorter in the MSU group compared with the control group (62 (52-71) vs 91,5 (75-97), p=0.006). Median (quartiles) mRS day 30 was 0 (0-1) in the MSU group and 0,5 (0-1,75) in the control group. No serious adverse events or symptomatic intracranial hemorrhages have occurred. Conclusion: The preliminary results indicate that adding diagnostics and treatment of acute stroke to the work-list of prehospital critical care physicians in an MSU-system, is timesaving and safe.