World's First 24/7 Mobile Stroke Unit: Initial 6-Month Experience at Mercy Health in Toledo, Ohio.

Eugene Lin,Julie Goins-Whitmore,Osama Zaidat,Victoria Calderon,Vibhav Bansal

doi:10.3389/fneur.2018.00283

Eugene Lin, Julie Goins-Whitmore + Show 3 more

Open Access

https://doi.org/10.3389/fneur.2018.00283

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Abstract

As the fourth mobile stroke unit (MSU) in the nation, and the first 24/7 unit worldwide, we review our initial experience with the Mercy Health MSU and institutional protocols implemented to facilitate rapid treatment of acute stroke patients and field triage for patients suffering other time-sensitive, acute neurologic emergencies in Lucas County, Ohio, and the greater Toledo metropolitan area. Data was prospectively collected for all patients transported and treated by the MSU during the first 6 months of service. Data was abstracted from documentation of on-scene emergency medical services (EMS) personnel, critical care nurses, and onboard physicians, who participated through telemedicine. The MSU was dispatched 248 times and transported 105 patients after on-scene examination with imaging. Intravenous (IV) tissue plasminogen activator (tPA) was administered to 10 patients; 8 patients underwent successful endovascular therapy after a large vessel occlusion was identified using CT performed within the MSU without post treatment symptomatic hemorrhage. Moreover, 14 patients were treated with IV anti-epileptics for status epilepticus, and 19 patients received IV anti-hypertensive agents for malignant hypertension. MSU alarm to on-scene times and treatment times were 34.7 min (25-49) and 50.6 min (44.4-56.8), respectively. The world's first 24/7 MSU has been successfully implemented with IV-tPA administration rates and times comparable to other MSUs nation-wide, while demonstrating rapid triage and treatment in the field for neurologic emergencies, including status epilepticus. With the rising number of MSUs worldwide, further data will drive standardized protocols that can be adopted nationwide by EMS.

Highlights

Stroke has fallen from the third to the fifth leading cause of death over the past decade because of advances in prevention and treatment (1)
Similar to data compiled from other mobile stroke unit (MSU), IV-tPA candidates received therapy under an hour of last known well (LKW) without increased complication rates
In addition to providing earlier therapy with thrombolytics for acute stroke patients, patients with hypertensive cerebral hemorrhage, status epilepticus, and/or severe vasogenic edema can receive rapid treatment. Initiation of these treatments is important as patients with hypertensive hemorrhage are at highest risk for rehemorrhage during the first 6–8 h

Summary

Introduction

Stroke has fallen from the third to the fifth leading cause of death over the past decade because of advances in prevention and treatment (1). The introduction of a mobile stroke unit (MSU), a specialized neuro-critical care ambulance with a portable CT scanner and telemedicine capabilities, circumvents this delay. They provide physicians the information and resources necessary to safely screen patients for IV-tPA eligibility and initiate thrombolytics in the field, significantly improving symptom onset to treatment times. As the fourth mobile stroke unit (MSU) in the nation, and the first 24/7 unit worldwide, we review our initial experience with the Mercy Health MSU and institutional protocols implemented to facilitate rapid treatment of acute stroke patients and field triage for patients suffering other time-sensitive, acute neurologic emergencies in Lucas County, Ohio, and the greater Toledo metropolitan area

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