WEDNESDAY, April 11 (HealthDay News) -- Clot-busting drugs can
help stave off lasting disability after a stroke, but they must be
given within a 4.5-hour window and many people arrive at the
hospital too late to use them.
Now, German researchers report that they think they have found a
solution to the problem: mobile stroke units. Equipped with what is
needed to diagnose and treat a stroke, these ambulances are stocked
with clot-busting tissue plasminogen activator (tPA) and the CT
scanning technology needed to confirm whether an ischemic stroke
has occurred, blood flow is blocked and it is safe to use tPA.
Unfortunately, while the mobile stroke units did speed the time
to treatment, this did not lead to improvements in neurological
outcomes or increase the number of people who received tPA. The
findings are published in the April 11 online edition of
The Lancet Neurology.
In the study conducted by Dr. Klaus Fassbender and his
colleagues from the University of the Saarland in Homburg, 100
people with suspected stroke were either treated in the mobile
stroke units or at the hospital. Use of mobile stroke units roughly
halved the time from the initial emergency call to treatment
decision, from 76 minutes to 35 minutes.
What's more, treatment in a mobile stroke unit also lowered the
time from symptom onset to therapy decision to less than an hour
for 57 percent of people. By contrast, just 4 percent who were
treated in the hospital were evaluated in under an hour.
The time from calling emergency services to administering
treatment was 38 minutes among people treated in the mobile unit
versus 73 minutes among those who were treated at the hospital, the
investigators found.
Commenting on the study, Dr. Larry Goldstein, director of the
Duke Stroke Center in Durham, N.C., said that while an interesting
concept, mobile stroke units may not be feasible in the United
States due to cost. "There might be some circumstances where such a
thing might be considered, but that would really have to be thought
through very carefully."
Unless and until that occurs, the best way to make sure that
people with suspected stroke get treatment promptly is to have 911
operators trained to recognize that a caller may be having a stroke
and dispatch the appropriate unit to take them to the nearest
stroke center where they can be evaluated and treated as quickly as
possible, Goldstein said.
Dr. Robert Glatter, an emergency medicine physician at Lenox
Hill Hospital in New York City, added that "the concept of a mobile
stroke unit is a promising approach to more rapidly and effectively
assess and treat patients with acute strokes in the field."
Some potential downsides include the cost of the set-up, Glatter
pointed out. "We will need an adequately powered, larger
multi-center trial to answer the question of whether largely
urban-based mobile stroke units ultimately improve outcome of
stroke patients in the 'time is brain' paradigm," he noted.
Glatter agreed that knowing the symptoms of a stroke is the most
important way to make sure that care is delivered in timely
fashion. Stroke symptoms may include facial drooping, difficulty
speaking, sudden numbness, dizziness and confusion.
More information
Is it a stroke? Learn the symptoms at the
National Stroke Association.