Joshua H Weinberg1, Ahmad Sweid2, Mauren DePrince3, John Roussis4, Nabeel Herial5, Michael Reid Gooch6, Hekmat Zarzour7, Stavropoula Tjoumakaris8, Thomas Topley9, Alvin Wang10, Gerald Wydro11, Lawrence Durland12, Robert Elliot13, James Fox14, Robert H Rosenwasser15, Pascal Jabbour16. 1. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Joshua.weinberg@jefferson.edu. 2. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: ahmad.sweid@jefferson.edu. 3. Department of Neuroscience, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Maureen.deprince@jefferson.edu. 4. Department of Neuroscience, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: john.roussis@jefferson.ed. 5. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: nabeel.herial@jefferson.edu. 6. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Reid.gooch@jefferson.edu. 7. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Hekmat.zarzour@jefferson.edu. 8. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: stavropoula.tjoumakaris@jefferson.edu. 9. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Thomas.topley@jefferson.edu. 10. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Alvin.wang@jefferson.edu. 11. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Gerald.wydro@jefferson.edu. 12. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Lawrence.durland@jefferson.edu. 13. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Robert.elliot@jefferson.edu. 14. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: James.fox@jefferson.edu. 15. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: robert.rosenwasser@jefferson.edu. 16. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: pascal.jabbour@jefferson.edu.
Abstract
BACKGROUND: Mobile stroke units (MSUs), specialized ambulances with a built-in computed tomography (CT) scanner and telemedicine connected stroke team, have been on the rise in recent years largely due to the 'time is brain' concept. We aim to report our initial experience since establishing our MSU, the first unit in the Tri-state area, and assess its impact on the stroke standards of care timeline. METHODS: We conducted a retrospective analysis of a prospectively maintained database of all MSU dispatched cases from August 2019 to March 2020. RESULTS: Of 195 MSU responses, 101 were treated and transported by the MSU. The mean time (hr:mm) of dispatch to scene arrival was 0:07+0:03, scene arrival to CT start was 0:10+0:03, CT start to teleneuro start was 0:05+0:03, teleneuro start to scene departure was 0:06+0:05, scene departure to hospital arrival was 0:12+0:06, and hospital arrival to arterial puncture was 2:59+1:01. The mean time of dispatch to arterial puncture was 3:34+1:02. The mean teleneuro consult duration was 0:04+0:02. The mean time of last know well (LKW) to tPA administration was 1:28+0:48 with 4 (57.1 %) patients receiving tPA within 60 min of LKW and 5 (71.4 %) patients receiving tPA within 90 min. The mean time of dispatch to tPA was 0:37+0:09 and scene arrival to tPA administration was 0:28+0:07. CONCLUSION: MSUs may expedite each step along the stroke standards of care. In theory, this should drastically improve functional outcomes. However, the impact on functional outcomes or reductions in stroke-related morbidity is still unknown.
BACKGROUND: Mobile stroke units (MSUs), specialized ambulances with a built-in computed tomography (CT) scanner and telemedicine connected stroke team, have been on the rise in recent years largely due to the 'time is brain' concept. We aim to report our initial experience since establishing our MSU, the first unit in the Tri-state area, and assess its impact on the stroke standards of care timeline. METHODS: We conducted a retrospective analysis of a prospectively maintained database of all MSU dispatched cases from August 2019 to March 2020. RESULTS: Of 195 MSU responses, 101 were treated and transported by the MSU. The mean time (hr:mm) of dispatch to scene arrival was 0:07+0:03, scene arrival to CT start was 0:10+0:03, CT start to teleneuro start was 0:05+0:03, teleneuro start to scene departure was 0:06+0:05, scene departure to hospital arrival was 0:12+0:06, and hospital arrival to arterial puncture was 2:59+1:01. The mean time of dispatch to arterial puncture was 3:34+1:02. The mean teleneuro consult duration was 0:04+0:02. The mean time of last know well (LKW) to tPA administration was 1:28+0:48 with 4 (57.1 %) patients receiving tPA within 60 min of LKW and 5 (71.4 %) patients receiving tPA within 90 min. The mean time of dispatch to tPA was 0:37+0:09 and scene arrival to tPA administration was 0:28+0:07. CONCLUSION: MSUs may expedite each step along the stroke standards of care. In theory, this should drastically improve functional outcomes. However, the impact on functional outcomes or reductions in stroke-related morbidity is still unknown.
Authors: Nathaniel R Ellens; Derrek Schartz; Redi Rahmani; Sajal Medha K Akkipeddi; Adam G Kelly; Curtis G Benesch; Stephanie A Parker; Jason L Burgett; Diana Proper; Webster H Pilcher; Thomas K Mattingly; James C Grotta; Tarun Bhalla; Matthew T Bender Journal: Front Neurol Date: 2022-05-09 Impact factor: 4.086