Abstract TP291: Melbourne Mobile Stroke Unit Increases Stroke Treatment Rates and Treatment Opportunities

Abstract

Background: The Melbourne Mobile Stroke Unit (MSU) is the first stroke ambulance in Australia. The MSU aims to provide rapid access to time critical treatments to acute stroke patients in the pre-hospital setting, thereby increasing the number of patients eligible for treatment. This is achieved by providing immediate access to expert stroke and ambulance personnel and the use of a mobile CT scanner. Methods: Data are prospectively collected on all MSU dispatches and compared to our local hospital database and Australian national standards. Results: The Melbourne MSU launched November 20 th 2017. It has been dispatched to 970 cases, of which 400 patients (41%) were attended by the MSU. Forty-two patients were thrombolysed (28% of all ischemic stroke versus the Australian average of 13% in-hospital thrombolysis), with a median scene-needle time of 40 mins (23-80mins). The median Australian door-needle time is 72 mins, with only 30% of patients treated within the internationally recommended 60 mins. Of the MSU thrombolysed patients, 12% were treated 3.5-4.5 hours from symptom onset; given ambulance transport and standard door-to-needle times, these patients would have been excluded from hospital-based lysis due to time. Additionally, the number of “golden hour” (onset-needle <60mins) thrombolysis patients has increased from 2% within our hospital to 12% on the MSU. Three patients had their anticoagulation reversed on the MSU with idarucizumab prior to thrombolysis and 1 patient received prothrombinex to manage a warfarin-related ICH. Nicardipine, labetalol and hydralazine are routinely used to manage BP. The MSU also provides a unique platform for hyperacute research trials, enrolling 10 patients into both ischemic and hemorrhagic stroke trials (utilising tenecteplase and tranexamic acid respectively). Conclusion: The Melbourne MSU more than doubles the rate of thrombolysis compared to in-hospital treatment and provides a comprehensive range of other novel treatments and opportunities. Consequently, the MSU allows more patients to be treated than the standard ambulance-hospital paradigm.