Monday, April 23, 2012

Mobile Stroke Units - Probably Not Helpful

Door to needle times too long?  Well, take the needle to the patient, then.

This is an interesting idea that, unfortunately, probably isn't a good idea.  They loaded a CT scanner, a stroke physician, a paramedic, and a mobile laboratory into a truck, and sent it out to meet acute stroke patients in the field.  The primary endpoint of the study - alarm to thrombolysis time - was great, with a mean time from alarm to therapy decision of 35 minutes.

The authors are very excited about the concept - as they feel the accelerated time scale in terms of acute stroke thrombolysis represents a paradigm shift in management.  Unfortunately, the patient-oriented outcomes - which were not part of the primary endpoint - don't support their enthusiasm.

All their safety and therapeutic outcomes are underpowered, but, out of their 47 intervention patients and 53 control (in-hospital thrombolysis) patients, 12 vs. 6 were treated stroke mimics and 3 vs. 0 were dead within 7 days.  Comorbidities and stroke severity should have favored the intervention group, so, these outcomes are surprising.  But, it is underpowered, so more data is needed.

"Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial."
http://www.ncbi.nlm.nih.gov/pubmed/22497929

4 comments:

  1. Talk about a Mobile Intensive Care Unit! I think in areas where you've got insane transport times this could be nice or want a better way of determining if a helicopter is appropriate. Otherwise a good in-hospital stroke protocol (including pre-hospital activation) would probably be more economical.

    Pretty neat idea though, reminds me of Dr. Frank Pantridge in Ireland and his radical idea to create Mobile Coronary Care Units and put defibrillators in them in the late 60's.

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  3. Unfortunately that´s one the biggest non-sense ideas of Germany´s current state in EM. While there´s still much suppression against EM becoming it´s own specialty, millions of euros are wasted with projects like this. Our pre-hospital system is working excellent, so in my opinion there´s no need to make it even more complicated and sophisticated, instead this money is needed to improve the structural problems in in-hospital EM, including professionalizing the docs working in the ER´s.

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  4. It boggles the mind that we're willing to build these incredibly sophisticated devices to serve a tiny subset of the population - when basic health needs for millions go unmet even in first-world countries. Yes, effective prevention of downstream costs from stroke disability represents a significant cost savings, but it's not clear to me that this sort of multi-million $ outlay is the most effective method at preventing future healthcare costs. Heck, the number of "I can't afford my insulin" patients I've admitted to the ICU in the last year....

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