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."