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A mobile stroke unit (MSU) is an
According to the 'time-is-brain' concept in acute stroke, recanalization of the obstructed blood vessels has to be performed within the very first hours after symptom onset. However, patients mostly come too late to the hospital and, therefore, only a minority of patients (5–10%) obtains the time-sensitive recanalizing treatments, and if so, mostly too late. As a potential solution to the problem of detrimental delays in stroke management the MSU concept was developed enabling diagnosis and treatment directly at the emergency site as opposed to awaiting the patient's arrival at hospital for treatment. By bringing imaging technology and stroke clinical expertise to the scene, teams are able to take advantage of the pre-hospital arrival time by focusing team efforts solely on one patient with suspected stroke.
Apart from the earlier start of treatment, knowledge about the type of stroke already in the pre-hospital phase of stroke management allows accurate triage decisions in regard to the most appropriate target hospital, e.g., hospital with or without endovascular or neurosurgical treatment options.
ambulance
An ambulance is a medically-equipped vehicle used to transport patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to ...
that furnishes services to diagnose, evaluate, and/or treat symptoms of an acute stroke
Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
. It may contain, in addition to the normal ambulance equipment, a device for brain imaging (computerized tomography
A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...
), a point-of-care laboratory and telemedical interaction between ambulance and hospital (videoconferencing, exchange of videos of patient examination and CT scans
A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...
). Thus, this specialized ambulance includes all the tools necessary for hyperacute assessment and treatment of stroke patients and diagnosis-based triage directly at the emergency site.
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Purpose
According to the 'time-is-brain' concept in acute stroke, recanalization of the obstructed blood vessels has to be performed within the very first hours after symptom onset. However, patients mostly come too late to the hospital and, therefore, only a minority of patients (5–10%) obtains the time-sensitive recanalizing treatments, and if so, mostly too late. As a potential solution to the problem of detrimental delays in stroke management the MSU concept was developed enabling diagnosis and treatment directly at the emergency site as opposed to awaiting the patient's arrival at hospital for treatment. By bringing imaging technology and stroke clinical expertise to the scene, teams are able to take advantage of the pre-hospital arrival time by focusing team efforts solely on one patient with suspected stroke.
Apart from the earlier start of treatment, knowledge about the type of stroke already in the pre-hospital phase of stroke management allows accurate triage decisions in regard to the most appropriate target hospital, e.g., hospital with or without endovascular or neurosurgical treatment options.
History and current evidence
The MSU concept was first published in 2003 and realized in clinical practice in 2008 by Fassbender et al. at Saarland University, Germany, adhering to current guidelines and legislations. It increased treatment rates and improved care of cerebral hemorrhage, when compared to conventional in-hospital care as shown by them and other groups at Berlin, Germany; Houston, Texas, United States; Cleveland, Ohio, United States; New York, New York, United States; or Drøbak and Oslo, Norway. In 2016, more than 20 sites are investigating this concept. In 2021, the preliminary results of the Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit (BEST-MSU) were published in theNew England Journal of Medicine
''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. Founded in 1812, the journal is among the most prestigious peer-reviewed medical journals. Its 2023 impact factor was ...
, demonstrating improved disability outcomes for acute stroke patients treated on a MSU compared to standard transport to the Emergency Department
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the Acute (medicine), ...
by Emergency Medical Services
Emergency medical services (EMS), also known as ambulance services, pre-hospital care or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to d ...
(EMS). Further studies on long-term outcomes, cost-effectiveness and best setting are underway.
Frazer, Ltd. a Houston, Texas–based emergency vehicle builder, designed and built the 1st MSU in the United States in January 2014. Their specialization in on-board generators for EMS vehicles made them the perfect fit to create an emergency vehicle that could handle the needs of a mobile CT scanner. NeuroLogica Corporation, a subsidiary of Samsung Electronics, provides the mCT, CereTom, enabling the ambulance to do critical CT scans to determine the status of the stroke. With input from leading neurologists, Frazer was able to build a functional space on wheels that helps to drastically cut down the time between onset symptoms and treatment.
References
{{Cerebrovascular diseases Ambulances Management of stroke