Fast treatment via mobile stroke unit reduced survivor disability

LOS ANGELES, Feb. 20, 2020 — Treating stroke patients in specialized ambulances speeds treatment and reduces patients’ disability, according to late breaking science presented today at the American Stroke Association’s International Stroke Conference 2020. The conference, Feb. 19-21 in Los Angeles, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

The Berlin Prehospital Or Usual Delivery (B_PROUD) trial investigated if prehospital treatment in a mobile stroke unit could improve patient outcomes compared to usual care, which was emergency transportation in a conventional ambulance and in-hospital treatment. Patients (total 749, average age 73, 46% females) were assigned to treatment based on the availability of three mobile stroke units in the metropolitan area of Berlin, Germany, and compared with patients (total 794, average age 74, 48% females) who received conventional care.

Mobile stroke units are ambulances staffed with emergency medicine neurologists and equipped with a CT scanner and a lab designed to enable specific stroke treatment at the scene. Prehospital treatment consisted of administering medications to dissolve the clot blocking blood flow in or to the brain (ischemic stroke). Timing is key because the clot-busting medication alteplase should be administered within 4.5 hours of stroke symptoms.

Researchers found that:

60% of patients assigned to the mobile stroke unit received clot-busting treatment with alteplase if a mobile stroke unit was available, compared to 48% of patients who received conventional treatment in the hospital;

the time to treatment was shortened by an average of 20 minutes when a mobile stroke unit was dispatched; and

the use of a mobile stroke unit reduced the likelihood and severity of disability and death at three months by 26%.

“While we had anticipated better outcomes in the patients treated in the mobile stroke units, we are amazed by the magnitude of the effects,” said lead study author Heinrich Audebert, M.D., professor in the department of neurology and Center for Stroke Research at Charité Universitätsmedizin in Berlin. “It is obvious that clot-busting treatment is most effective if it is applied in the ultra-early phase of stroke – ideally within the first or ‘golden hour’ of symptom onset.”

Since treatment within the first hour of symptom onset happens rarely in conventional care, Audebert said health care providers should consider ways to optimize treatment so it can begin while in route to the hospital.

“Stroke treatment is more effective the earlier it starts,” he said. “Just waiting until the patient arrives at the hospital is not enough anymore.”

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The list of study authors and disclosures are available in the abstract. The study was funded by the German Research Foundation and the Ministry of Education and Research.

Additional Resources:

VIDEO Perspective from Mitchell S. V. Elkind, M.D., M.S., FAHA, FAAN, president elect of the American Heart Association, may be downloaded on the right column of the release link along with any additional, available multimedia.

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AHA News Release: Mobile stroke units could expedite treatment and improve patient outcomes in urban areas

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The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science of stroke and brain health. ISC 2020 will be held February 19-21 at the Los Angeles Convention Center in California. The 2 ½-day conference features more than 1,600 compelling scientific presentations in 21 categories that emphasize basic, clinical and translational science for health care professionals and researchers. These science and other clinical presentations will provide attendees with a better understanding of stroke and brain health to help improve prevention, treatment and outcomes for the more than 800,000 Americans who have a stroke each year. Stroke is the fifth leading cause of death and a leading cause of serious, long-term disability in the U.S. Worldwide, cerebrovascular accidents (stroke) are the second leading cause of death and the third leading cause of disability, according to the World Health Organization. Engage in the International Stroke Conference on social media via #ISC20.

About the American Stroke Association

The American Stroke Association is a relentless force for a world with fewer strokes and longer, healthier lives. We team with millions of volunteers and donors to ensure equitable health and stroke care in all communities. We work to prevent, treat and beat stroke by funding innovative research, fighting for the public’s health, and providing lifesaving resources. The Dallas-based association was created in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit strokeassociation.org. Follow us on Facebook and Twitter.