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"Mobile Stroke"

Olli S Mattila, Tuukka Puolakka, Juhani Ritvonen, Saana Pihlasviita, Heini Harve, Ari Alanen, Gerli Sibolt, Sami Curtze, Daniel Strbian, Mikko Pystynen, Turgut Tatlisumak, Markku Kuisma, Perttu J Lindsberg
BACKGROUND: Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest. AIMS: We sought to identify targets for improving dispatcher stroke identification. METHODS: Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies...
February 13, 2019: International Journal of Stroke: Official Journal of the International Stroke Society
Zi Wang, Yuchuan Ding, Paul Fu
Stroke is a leading cause of disability in the United States and current treatment for stroke is limited to two modalities with well-defined time restraints. The prehospital setting is a significant and relatively easy setting for innovation in stroke care, as the most clinical decisions are made within the first several hours of symptom onset. In this review, we look at recent innovations in improving prehospital care for acute stroke including the conception of mobile stroke units, the ongoing development of stroke models for emergency providers, barriers to prehospital care, and the innovation of new telephone applications...
October 2018: Brain Circulation
D A Cadilhac, S S Rajan, J Kim
No abstract text is available yet for this article.
January 25, 2019: Current Atherosclerosis Reports
Silke Walter, Iris Q Grunwald, Stefan A Helwig, Andreas Ragoschke-Schumm, Michael Kettner, Mathias Fousse, Martin Lesmeister, Klaus Fassbender
No abstract text is available yet for this article.
January 25, 2019: Current Atherosclerosis Reports
James P Rhudy, Anne W Alexandrov, Joseph Rike, Tomas Bryndziar, Ana Hossein Zadeh Maleki, Victoria Swatzell, Wendy Dusenbury, E Jeffrey Metter, Andrei V Alexandrov
Background: Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. Methods: We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true stroke by zip code and calculated dispatch and true stroke incidence rates...
October 2018: Interventional Neurology
Victoria J Calderon, Brittany M Kasturiarachi, Eugene Lin, Vibhav Bansal, Osama O Zaidat
Background: The treatment of stroke is dependent on a narrow therapeutic time window that requires interventions to be emergently pursued. Despite recent "FAST" initiatives that have underscored "time is brain," many patients still fail to present within the narrow time window to receive maximum treatment benefit from advanced stroke therapies, including recombinant tissue plasminogen activator (tPA) and mechanical thrombectomy. The convergence of emergency medical services, telemedicine, and mobile technology, including transportable computed tomography scanners, has presented a unique opportunity to advance patient stroke care in the prehospital field by shortening time to hyperacute stroke treatment with a mobile stroke unit (MSU)...
October 2018: Interventional Neurology
Sarah A Moore, Nina Hrisos, Darren Flynn, Linda Errington, Christopher Price, Leah Avery
BACKGROUND: Increasing physical activity (PA) levels (regular movement such as walking and activities of daily living) and reducing time spent sedentary improves cardiovascular health and reduces morbidity and mortality. Fewer than 30% of independently mobile stroke survivors undertake recommended levels of PA. Sedentary behaviour is also high in this population. We aimed to systematically review the study characteristics and the promise of interventions targeting free-living PA and/or sedentary behaviour in adult stroke survivors...
October 17, 2018: International Journal of Behavioral Nutrition and Physical Activity
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
OBJECTIVE: 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 prehospital environment leading to treatment delays. Intraosseous (IO) access is commonly used in the prehospital setting for a variety of conditions and may serve as a viable means for tPA (tissue plasminogen activator) administration. METHODS/RESULTS: 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...
October 25, 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. Methods- MSU-GH patients were selected from the Berlin-based MSU (STEMO [Stroke Emergency Mobile]), whereas HS-GH patients were selected from the SITS-EAST (Safe Implementation of Treatments in Stroke-East) registry...
August 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...
November 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
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