Mobile Stroke Unit and Mechanical Thrombectomy Workflow: A Single Center 5-Year Experience

Area of Science:

• Neurology
• Emergency Medicine
• Health Services Research

Background:

• Mobile stroke units (MSUs) improve treatment times and outcomes for acute ischemic stroke, particularly for intravenous thrombolysis.
• Limited data exists on MSU impact for endovascular treatment (EVT)-eligible patients outside clinical trials.
• Investigating MSU workflow benefits versus standard emergency medical services (EMS) for EVT-eligible patients is crucial.

Purpose of the Study:

• To compare the workflow efficiency and treatment times of MSU-transported versus EMS-transported patients eligible for mechanical thrombectomy.
• To evaluate the impact of MSU care on key time metrics and clinical outcomes in this patient population.

Main Methods:

• Retrospective, cross-sectional study of a single-center mechanical thrombectomy database (June 2018 - November 2023).
• Patients were divided into MSU-transported and EMS-transported (mothership) groups presenting during MSU operating hours.
• Comparison of treatment time metrics and clinical outcomes between the two groups.

Main Results:

• 66 patients were transported via MSU and 499 via EMS.
• MSU patients had significantly shorter door to angio (41 vs. 62 min), door to puncture (58 vs. 82 min), and door to reperfusion (96 vs. 127 min) times (P<0.001).
• Time from last known well to puncture was shorter for MSU patients (237 vs. 389 min; P=0.021).

Conclusions:

• MSU transport is associated with significantly improved time metrics for EVT-eligible stroke patients compared to standard EMS.
• Functional outcomes at 90 days and rates of intracerebral hemorrhage were comparable between MSU and EMS groups.
• MSU care offers workflow advantages for EVT-eligible stroke patients without compromising safety or long-term outcomes.