Praveen Hariharan1, Muhammad Bilal Tariq1, James C Grotta2, Alexandra L Czap3. 1. Department of Neurology, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin St, MSB 7.044, Houston, TX, 77030, USA. 2. Clinical Innovation and Research Institute, Memorial Hermann Hospital Texas Medical Center, Houston, TX, USA. 3. Department of Neurology, McGovern Medical School at the University of Texas Health Science Center, 6431 Fannin St, MSB 7.044, Houston, TX, 77030, USA. czap.library@gmail.com.
Abstract
PURPOSE OF REVIEW: Several approaches have been developed to optimize prehospital systems for acute stroke given poor access and significant delays to timely treatment. Specially equipped ambulances that directly initiate treatment, known as Mobile Stroke Units (MSUs), have rapidly proliferated across the world. This review provides a comprehensive summary on the efficacy of MSUs in acute stroke, its various applications beyond thrombolysis, as well as the establishment, optimal setting and cost-effectiveness of incorporating an MSU into healthcare systems. RECENT FINDINGS: MSUs speed stroke treatment into the first "golden hour" when better outcomes from thrombolysis are achieved. While evidence for the positive impact of MSUs on outcomes was previously unavailable, two recent landmark controlled trials, B_PROUD and BEST-MSU, show that MSUs result in significantly lesser disability compared to conventional ambulance care. Emerging literature prove the significant impact of MSUs. Adaptability however remains limited by significant upfront financial investment, challenges with reimbursements and pending evidence on their cost-effectiveness.
PURPOSE OF REVIEW: Several approaches have been developed to optimize prehospital systems for acute stroke given poor access and significant delays to timely treatment. Specially equipped ambulances that directly initiate treatment, known as Mobile Stroke Units (MSUs), have rapidly proliferated across the world. This review provides a comprehensive summary on the efficacy of MSUs in acute stroke, its various applications beyond thrombolysis, as well as the establishment, optimal setting and cost-effectiveness of incorporating an MSU into healthcare systems. RECENT FINDINGS: MSUs speed stroke treatment into the first "golden hour" when better outcomes from thrombolysis are achieved. While evidence for the positive impact of MSUs on outcomes was previously unavailable, two recent landmark controlled trials, B_PROUD and BEST-MSU, show that MSUs result in significantly lesser disability compared to conventional ambulance care. Emerging literature prove the significant impact of MSUs. Adaptability however remains limited by significant upfront financial investment, challenges with reimbursements and pending evidence on their cost-effectiveness.
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Authors: Joon-Tae Kim; Gregg C Fonarow; Eric E Smith; Mathew J Reeves; Digvijaya D Navalkele; James C Grotta; Maria V Grau-Sepulveda; Adrian F Hernandez; Eric D Peterson; Lee H Schwamm; Jeffrey L Saver Journal: Circulation Date: 2016-11-04 Impact factor: 29.690
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Authors: Ritvij Bowry; Stephanie Parker; Suja S Rajan; Jose-Miguel Yamal; Tzu-Ching Wu; Laura Richardson; Elizabeth Noser; David Persse; Kamilah Jackson; James C Grotta Journal: Stroke Date: 2015-10-27 Impact factor: 7.914
Authors: William J Powers; Alejandro A Rabinstein; Teri Ackerson; Opeolu M Adeoye; Nicholas C Bambakidis; Kyra Becker; José Biller; Michael Brown; Bart M Demaerschalk; Brian Hoh; Edward C Jauch; Chelsea S Kidwell; Thabele M Leslie-Mazwi; Bruce Ovbiagele; Phillip A Scott; Kevin N Sheth; Andrew M Southerland; Deborah V Summers; David L Tirschwell Journal: Stroke Date: 2019-10-30 Impact factor: 7.914
Authors: Salim S Virani; Alvaro Alonso; Hugo J Aparicio; Emelia J Benjamin; Marcio S Bittencourt; Clifton W Callaway; April P Carson; Alanna M Chamberlain; Susan Cheng; Francesca N Delling; Mitchell S V Elkind; Kelly R Evenson; Jane F Ferguson; Deepak K Gupta; Sadiya S Khan; Brett M Kissela; Kristen L Knutson; Chong D Lee; Tené T Lewis; Junxiu Liu; Matthew Shane Loop; Pamela L Lutsey; Jun Ma; Jason Mackey; Seth S Martin; David B Matchar; Michael E Mussolino; Sankar D Navaneethan; Amanda Marma Perak; Gregory A Roth; Zainab Samad; Gary M Satou; Emily B Schroeder; Svati H Shah; Christina M Shay; Andrew Stokes; Lisa B VanWagner; Nae-Yuh Wang; Connie W Tsao Journal: Circulation Date: 2021-01-27 Impact factor: 29.690