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Abstract Details

Clinical Outcomes After Pre-hospital Thrombolysis on a Mobile Stroke Unit
Cerebrovascular Disease and Interventional Neurology
S57 - Acute Treatment and Imaging of Ischemic Stroke (1:33 PM-1:44 PM)
004
In July 2014, we launched a MSU in the Cleveland, Ohio area. By eliminating transport time, and organizing an efficient MSU team, we shortened the time to IVT in patients with AIS.
We sought to demonstrate the effects of reduced time to treatment with intravenous thrombolysis (IVT) using a mobile stroke unit (MSU), on clinical outcomes after acute ischemic stroke (AIS).

We prospectively identified patients who received IVT from July 2014-December 2017, and compared patients with pre-hospital IVT on MSU with patients brought to the ED via a conventional ambulance. The primary outcome was modified Rankin scale score (mRS) of 1 or better at 90 days. Binary logistic regression model of 90-day mRS for 0-1 vs 2-6 was adjusted for age, initial National Institutes of Health Stroke Scale (NIHSS) score, and pre-morbid mRS.


Seventy-eight patients received IVT in the MSU, and 153 patients received IVT in the ED. No significant differences were seen in gender, age, pre-morbid mRS, initial NIHSS, or risk factors between the groups.  MSU patients received IVT 38 minutes earlier from onset, than the ED patients (median 79 vs. 117 minutes, p<0.001). In an unadjusted analysis, the difference in primary outcome between MSU and ED groups was not significant (41% with MSU vs. 29% with ED, p=0.061). After adjustment for age, initial NIHSS score, and premord mRS, the odds ratio for mRS 0-1 at 90 days with IVT on MSU compared to ED was 2.09 (95% confidence interval (CI), 1.02-4.28, p = 0.044). Following adjustment for time from onset to IVT, the effect of MSU on 90-day mRS was attenuated, and no longer significant (odds ratio 1.65, 95% CI, 0.77-3.55, p=0.196).


Pre-hospital IVT on MSU compared to conventional ED care shortened the time to IVT, and was associated with improved clinical outcomes in patients with AIS.
Authors/Disclosures
Andrew Russman, DO, FAAN (Cleveland Clinic)
PRESENTER
Dr. Russman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific Corporation. Dr. Russman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Russman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech.
No disclosure on file
Lila E. Sheikhi, MD (Hawthorn Health, LLC) Dr. Sheikhi has nothing to disclose.
No disclosure on file
Nicholas Thompson Nicholas Thompson has nothing to disclose.
No disclosure on file
Muhammad S. Hussain, MD (Cleveland Clinic) Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Hussain has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tiger Medical.
Ken Uchino, MD (Cleveland Clinic Foundation) Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.