Stroke patients received clot-busting medications such as tissue plasminogen activator (tPA) faster, more often, and recovered significantly better when treated via a mobile stroke unit (MSU) compared to standard management by Emergency Medical Services (EMS), according to researchers with The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann-Texas Medical Center (TMC).
The research was presented today at the American Heart Association’s International Stroke Conference.
“Receiving tPA within the first hour after the onset of stroke symptoms is critical to improving a patient’s outcome. Because the MSU is able to bring stroke treatment to the patient rather than awaiting arrival to the Emergency Department, we were able to treat one-third of patients within that time frame compared to only 3% of those receiving standard management” said James Grotta, MD, director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann-TMC, director of the Houston Mobile Stroke Unit Consortium, a neurologist with the Memorial Hermann Medical Group, and corresponding author of the study. “We also were able to treat 97% of eligible patients transported by a MSU, compared to 80% brought to the emergency department by ambulance.”
Researchers found 53% of patients treated by a MSU made a complete recovery from their stroke after three months compared to 43% of patients not treated on a mobile stroke unit. These findings provide evidence that the earlier stroke treatment begins, especially within the first hour after it occurs, the more responsive the brain and blood clots are to effective treatment.
“This underscores the importance of patients and bystanders to be aware of the signs of a stroke and to call 911 immediately,” said Grotta.
The research is part of the ongoing BEST-MSU study and examined data from more than 1,000 patients who suffered an ischemic stroke and were eligible for tPA at seven centers which included Houston, between 2014 and 2020.
In 2014, McGovern Medical School at UTHealth was the first in the nation to launch a mobile stroke unit, a specially equipped ambulance for diagnosing and treating stroke rapidly before hospital arrival. The UTHealth mobile stroke unit team, in partnership with Memorial Hermann and other local hospitals, is able to quickly provide an ischemic stroke patient with tPA.
According to the U.S. Centers for Disease Control and Prevention, stroke is the fifth leading cause of death in the United States and a major contributor to long-term disability and in the United States, someone has a stroke every 40 seconds. Approximately 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked.
“It’s important for all of us to be aware of the signs of a stroke and call 911 immediately,” Grotta added. “We hope to eventually see more widespread deployment of mobile stroke units which have a public health impact on reducing disability from stroke.” More research is ongoing by Grotta and the team at UTHealth to assess health care utilization over the entire year following a patient’s stroke, which will enable a better idea of the cost effectiveness of mobile stroke unit implementation on a wider scale.
“Although mobile stroke units have started to appear throughout U.S., there had been no research showing that they actually contributed to better patient outcomes,” said Jose-Miguel Yamal, PhD, an associate professor of biostatistics with UTHealth School of Public Health and senior author of the study. “The BEST-MSU study is the first U.S. study that shows mobile stroke units are able to treat ischemic stroke patients earlier in the ‘golden hour’ just after stroke symptom-onset, and this translates to less disability in patients. We found 10% fewer people had disability with MSU compared to standard emergency medical services. Importantly, these results were consistent across race and sex groups. If mobile stroke units are more widely adopted, this may have a large impact on public health by changing the practice of pre-hospital care, leading to earlier treatment of stroke and better patient outcomes.”
UTHealth School of Public Health served as the data coordinating center for the BEST-MSU trial, collaborating with McGovern Medical School, Memorial Hermann, and seven diverse sites to conduct the trial. The research was conducted in cooperation with Houston, Bellaire, and West University fire departments, and participation of all stroke centers in Houston.
Co-authors of the study affiliated with the UTHealth School of Public Health include Suja Rajan, PhD; Asha P. Jacob, MD; Mengxi Wang, PhD; Noopur Singh, MPH; and Michael Gonzalez, MPH. Co-authors affiliated with McGovern Medical School include Stephanie A. Parker, MHA, BSN, RN, director for the UTHealth mobile stroke unit; Nicole Gonzales, MD; David Persse, MD; Patti Bratina, RN; James McCarthy, MD, executive vice president and chief physician executive with Memorial Hermann Health System; Nicole Rangel-Gutierrez, NP; Edgar Lechuga, RN; Jonathan Stephenson, RN; Kenny Phan, RTR, CT Yvette Sanders; Elizabeth Noser, MD; and Ritvij Bowry, MD.
The study was supported by the Patient Centered Outcomes Research Institute, the American Heart Association, and Genentech.
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-Press release adapted from Memorial Hermann Hospital