Prospective, Multicenter, Controlled Trial of Mobile Stroke Units

SPS commentary:

Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment with tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). In the study, it was also noted that the median time from onset of stroke to administration of t-PA was 72 minutes in the MSU group and 108 minutes in the EMS group and of patients eligible for t-PA, 97.1% in the MSU group received t-PA, as compared with 79.5% in the EMS group.

According to an editorial, this trial ran in parallel with a mutually supportive European trial, the Berlin Prehospital or Usual Delivery of Acute Stroke Care 2.0 (B_PROUD 2.0) in Berlin, which found that the dispatch of mobile stroke units to 749 patients, as compared with conventional ambulances dispatched to 794 patients, was associated with modest but lower global disability at 3 months, as well as a 25% difference in the percentage of patients who were able to receive thrombolysis (60.2% vs. 48.1%) and a 20-minute difference in the median time from stroke onset until initiation of thrombolytic treatment (50 minutes vs. 70 minutes). It suggests that after two independent trials, it appears reasonable to conclude that mobile stroke units expedite both assessment and treatment in patients with acute stroke and deliver treatment to more eligible patients, improving average outcomes for patients with a final diagnosis of acute cerebral ischaemia but particularly among those who are eligible for, and who received, thrombolysis. It acknowledges that although stroke-specific emergency medical service vehicles and staff are expensive, the societal and financial burdens that are associated with untreated stroke are sufficient for social pressure to build to introduce mobile stroke units more widely.