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"Mobile Stroke"

Alfonso Ciccone, Eivind Berge, Urs Fischer
Background Intra-arterial treatment of acute ischemic stroke requires changes to acute stroke services since most hospitals do not have on-site intra-arterial treatment facilities. Aim To identify models for delivery of intra-arterial treatment and to compare process performance and clinical and radiological outcomes of the different models. Methods We systematically searched the literature and contacted experts in the field. We performed a qualitative synthesis to identify models, and a quantitative review and meta-analysis of clinical and radiological outcomes under different organizational models...
October 10, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Frederik Geisler, Syed F Ali, Martin Ebinger, Alexander Kunz, Michal Rozanski, Carolin Waldschmidt, Joachim E Weber, Matthias Wendt, Benjamin Winter, Lee H Schwamm, Heinrich J Audebert
Background Patients with a sudden onset of focal neurological deficits consistent with stroke, who turn out to have alternative conditions, have been labeled stroke mimics. Aims We assessed a recently validated telemedicine-based stroke mimic score (TeleStroke mimic score; TM-score) and individual patient characteristics with regard to its discriminative value between cerebrovascular disease and stroke mimic patients in the in-person, pre-hospital setting. Methods We evaluated patients cared for in a mobile stroke unit in Berlin, Germany...
October 10, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Ritvij Bowry, May Nour, Teresa Kus, Stephanie Parker, Jonathan Stephenson, Jeffrey Saver, James C Grotta, Daniel Ostermayer
Mobile stroke units offer improved time to administration of thrombolytics for ischemic stroke patients. Acquisition of intravenous (IV) access, however, can be challenging in the pre-hospital environment leading to treatment delays. Intraosseous (IO) access is commonly used in the pre-hospital setting for a variety of conditions and may serve as a viable means for tPA (tissue plasminogen activator) administration. We describe 3 cases in which tPA was administered via IO access on a mobile stroke unit as part of the Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services (BEST-MSU) trial...
September 20, 2018: Prehospital Emergency Care
Tamara A Sloper
No abstract text is available yet for this article.
September 2018: Journal of Nuclear Medicine Technology
Silke Walter, Iris Q Grunwald, Stefan A Helwig, Andreas Ragoschke-Schumm, Michael Kettner, Mathias Fousse, Martin Lesmeister, Klaus Fassbender
PURPOSE OF REVIEW: Acute stroke is a treatable disease. Nevertheless, only a minority of patients obtain guideline-adjusted therapy. One major reason is the small time window in which therapies have to be administered in order to reverse or mitigate brain injury and prevent disability. The Mobile Stroke Unit (MSU) concept, available for a decade now, is spreading worldwide, comprising ambulances, fully equipped with computed tomography, laboratory unit and telemedicine connection to the stroke centre and staffed with a specialised stroke team...
August 29, 2018: Current Atherosclerosis Reports
Silke Walter, Henry Zhao, Damien Easton, Cees Bil, Jonas Sauer, Yang Liu, Martin Lesmeister, Iris Q Grunwald, Geoffrey A Donnan, Stephen M Davis, Klaus Fassbender
Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites...
August 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Henry Zhao, Skye Coote, Lauren Pesavento, Brett Jones, Edrich Rodrigues, Jo Lyn Ng, Felix Ng, Bernard Yan, Mark Parsons, Bruce Cv Campbell, Damien Easton, Geoffrey A Donnan, Stephen M Davis
Background Administration of intravenous idarucizumab to reverse dabigatran anticoagulation prior to thrombolysis for patients with acute ischemic stroke has been previously described, but not in the prehospital setting. The speed and predictability of idarucizumab reversal is well suited to prehospital treatment in a mobile stroke unit and allows patients with recent dabigatran intake to access reperfusion therapy. Aims To describe feasibility of prehospital idarucizumab administration prior to thrombolysis on the Melbourne mobile stroke unit...
July 17, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Ashfaq Shuaib, Thomas Jeerakathil
No abstract text is available yet for this article.
July 16, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Georgios Tsivgoulis, Frederik Geisler, Aristeidis H Katsanos, Janika Kõrv, Alexander Kunz, Robert Mikulik, Michal Rozanski, Matthias Wendt, Heinrich J Audebert
BACKGROUND AND PURPOSE: Mobile stroke units (MSUs) are known to increase the proportion of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) in the first golden hour (GH) after onset compared with hospital settings (HS). However, because of the low number of AIS patients treated with intravenous thrombolysis within this ultraearly time window in conventional care, characteristics, and outcome of this subgroup of AIS patients have not been compared between MSU and HS...
July 9, 2018: Stroke; a Journal of Cerebral Circulation
S Walter, A Ragoschke-Schumm, M Lesmeister, S A Helwig, M Kettner, I Q Grunwald, K Fassbender
BACKGROUND: Acute ischemic stroke is a treatable disease. Moreover, there is increasing evidence supporting mechanical recanalization for large-vessel occlusion, even beyond a strict time window. However, only small numbers of patients receive causal treatment. METHODS: One of the main reasons that patients do not receive causal therapy is their late arrival at the correct target hospital, which, depending on the type of stroke, is either a regional stroke unit or a comprehensive stroke center for interventional treatment...
June 8, 2018: Der Radiologe
Qiang Huang, Jing-Ze Zhang, Wen-Deng Xu, Jian Wu
The generalization of successful efforts for reducing time delays in intravenous thrombolysis (IVT) could help facilitate its utility and benefits in acute ischemic stroke (AIS) patients.We searched the PubMed and Embase databases for articles reporting interventions to reduce time delays in IVT, published between January 1995 and September 2017. The IVT rate was chosen as the primary outcome, while the compliance rates of onset-to-door time (prehospital delay) and door-to-needle time (in-hospital delay) within the targeted time frame were the secondary outcomes...
June 2018: Medicine (Baltimore)
Eugene Lin, Victoria Calderon, Julie Goins-Whitmore, Vibhav Bansal, Osama Zaidat
Background and purpose: As the fourth mobile stroke unit (MSU) in the nation, and the first 24/7 unit worldwide, we review our initial experience with the Mercy Health MSU and institutional protocols implemented to facilitate rapid treatment of acute stroke patients and field triage for patients suffering other time-sensitive, acute neurologic emergencies in Lucas County, Ohio, and the greater Toledo metropolitan area. Methods: Data was prospectively collected for all patients transported and treated by the MSU during the first 6 months of service...
2018: Frontiers in Neurology
E M Nyberg, J R Cox, R G Kowalski, D Vela-Duarte, B Schimpf, W J Jones
Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy...
July 2018: AJNR. American Journal of Neuroradiology
Ritvij Bowry, Stephanie A Parker, Jose-Miguel Yamal, Hyunsoo Hwang, Savitri Appana, Nicole Rangel-Gutierrez, Tzu-Ching Wu, Suja S Rajan, James C Grotta
BACKGROUND AND PURPOSE: Mobile stroke units (MSUs) can speed treatment with intravenous tPA (tissue-type plasminogen activator). We previously showed substantial agreement between a telemedicine-based vascular neurologist (TM-VN) and an onboard vascular neurologist (OB-VN) for the evaluation of patients with stroke for tPA eligibility on an MSU. However, the time efficiency of the telemedicine-based evaluation remained uncertain. In this study, we examined the speed of decision and treatment from MSU arrival for the TM-VN compared with an OB-VN...
June 2018: Stroke; a Journal of Cerebral Circulation
Bruce Cv Campbell, Mark W Parsons
This review summarizes the current state of knowledge regarding the use of imaging to guide stroke treatment. Brain imaging plays a central role in the diagnosis of stroke and identification of the mechanism of stroke, which is relevant to acute treatment, prognosis, and secondary prevention. The chief potential modalities are computed tomography (CT) and magnetic resonance imaging (MRI). Currently, most imaging occurs in hospital but mobile stroke units have expanded CT brain imaging into the prehospital field...
August 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Kristi G Bache, Maren Ranhoff Hov, Karianne Larsen, Volker Moræus Solyga, Christian G Lund
BACKGROUND: Acute ischemic stroke (AIS) is a medical emergency. The outcome is closely linked to the time elapsing from symptom onset to treatment, and seemingly small delays can mean the difference between full recovery and physical and cognitive dysfunction. Recanalization to allow blood to reenter the affected area is most efficient immediately after symptoms occur, and intravenous thrombolysis must be initiated no later than 4.5 hours after the symptom onset. A liable diagnosis is mandatory to administer the appropriate treatment...
February 28, 2018: JMIR Research Protocols
S L Nicholson, C A Greig, F Sniehotta, M Johnston, S J Lewis, M E McMurdo, D Johnston, J Scopes, G E Mead
BACKGROUND: Levels of physical activity after stroke are low, despite multiple health benefits. We explored stroke survivors' perceived barriers, motivators, self-efficacy and intention to physical activity. METHODS: Fifty independently mobile stroke survivors were recruited prior to hospital discharge. Participants rated nine possible motivators and four possible barriers based on the Mutrie Scale, as having 'no influence', 'some influence' or 'a major influence' on physical activity...
September 2017: Journal of the Royal College of Physicians of Edinburgh
Benjamin R Kummer, Michael P Lerario, Babak B Navi, Adam C Ganzman, Daniel Ribaudo, Saad A Mir, Sammy Pishanidar, Tim Lekic, Olajide Williams, Hooman Kamel, Randolph S Marshall, George Hripcsak, Mitchell S V Elkind, Matthew E Fink
BACKGROUND: Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied. OBJECTIVE: The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts...
January 2018: Applied Clinical Informatics
Ritvij Bowry, James C Grotta
Ischemic stroke results from blocked arteries in the brain, with earlier thrombolysis with intravenous tissue plasminogen activator (tPA) and/or mechanical thrombectomy resulting in improved clinical outcomes. Mobile Stroke Unit (MSU) can speed up the treatment with tPA and facilitate faster triage for patients to hospitals for mechanical thrombectomy. The first registry-based MSU study in Germany demonstrated faster treatment times with tPA using a MSU, a higher proportion of patients being treated within the first "golden hour," and a suggestion of improved 3-month clinical outcomes...
December 2017: Seminars in Respiratory and Critical Care Medicine
Maren R Hov, Jo Røislien, Thomas Lindner, Erik Zakariassen, Kristi C G Bache, Volker M Solyga, David Russell, Christian G Lund
BACKGROUND: Cerebral revascularization in acute stroke requires robust diagnostic tools close to symptom onset. The quantitative National Institute of Health Stroke Scale (NIHSS) is widely used in-hospital, whereas shorter and less specific stroke scales are used in the prehospital field. This study explored the accuracy and potential clinical benefit of using NIHSS prehospitally. PATIENTS AND METHODS: Thirteen anesthesiologists trained in prehospital critical care enrolled patients with suspected acute stroke in a mobile stroke unit...
December 12, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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