Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/22653
Title: Melbourne Mobile Stroke Unit and Reperfusion Therapy: Greater Clinical Impact of Thrombectomy Than Thrombolysis.
Authors: Zhao, Henry;Coote, Skye;Easton, Damien;Langenberg, Francesca;Stephenson, Michael;Smith, Karen;Bernard, Stephen;Cadilhac, Dominique A;Kim, Joosup;Bladin, Christopher F;Churilov, Leonid;Crompton, Douglas E;Dewey, Helen M;Sanders, Lauren M;Wijeratne, Tissa;Cloud, Geoffrey;Brooks, Duncan Mark;Asadi, Hamed;Thijs, Vincent N;Chandra, Ronil V;Ma, Henry;Desmond, Patricia M;Dowling, Richard J;Mitchell, Peter J;Yassi, Nawaf;Yan, Bernard;Campbell, Bruce C V;Parsons, Mark W;Donnan, Geoffrey A;Davis, Stephen M
Affiliation: Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Department of Radiology, Royal Melbourne Hospital, Victoria, Australia
Department of Community Emergency Health and Paramedic Practice, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
From the Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Victoria, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Translational Public Health Research Division, Stroke and Ageing Research Group, School of Clinical Sciences Department of Neurology, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Discipline of Emergency Medicine, University of Western Australia, Australia
Ambulance Victoria, Melbourne, Victoria, Australia
Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Department of Clinical Neurosciences, Central Clinical School, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Alfred Health, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Neurology, Northern Health, Faculty of Medicine, Dentistry and Health Sciences, Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Department of Neurology St. Vincent's Hospital Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
Department of Neurology, Western Health, Faculty of Medicine, Dentistry and Health Sciences, Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
Department of Radiology,Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Department of Neurology, Monash Health, Department of Medicine, School of Clinical Science, Monash University, Melbourne, Victoria, Australia
Issue Date: Mar-2020
EDate: 2020-02-12
Citation: Stroke 2020; 51(3): 922-930
Abstract: Background and Purpose- Mobile stroke units (MSUs) are increasingly used worldwide to provide prehospital triage and treatment. The benefits of MSUs in giving earlier thrombolysis have been well established, but the impacts of MSUs on endovascular thrombectomy (EVT) and effect on disability avoidance are largely unknown. We aimed to determine the clinical impact and disability reduction for reperfusion therapies in the first operational year of the Melbourne MSU. Methods- Treatment time metrics for MSU patients receiving reperfusion therapy were compared with control patients presenting to metropolitan Melbourne stroke units via standard ambulance within MSU operating hours. The primary outcome was median time difference in first ambulance dispatch to treatment modeled using quantile regression analysis. Time savings were subsequently converted to disability-adjusted life years avoided using published estimates. Results- In the first 365-day operation of the Melbourne MSU, prehospital thrombolysis was administered to 100 patients (mean age, 73.8 years; 62% men). The median time savings per MSU patient, compared with the control cohort, was 26 minutes (P<0.001) for dispatch to hospital arrival and 15 minutes (P<0.001) for hospital arrival to thrombolysis. The calculated overall time saving from dispatch to thrombolysis was 42.5 minutes (95% CI, 36.0-49.0). In the same period, 41 MSU patients received EVT (mean age, 76 years; 61% men) with median dispatch-to-treatment time saving of 51 minutes ([95% CI, 30.1-71.9], P<0.001). This included a median time saving of 17 minutes ([95% CI, 7.6-26.4], P=0.001) for EVT hospital arrival to arterial puncture for MSU patients. Estimated median disability-adjusted life years saved through earlier provision of reperfusion therapies were 20.9 for thrombolysis and 24.6 for EVT. Conclusions- The Melbourne MSU substantially reduced time to reperfusion therapies, with the greatest estimated disability avoidance driven by the more powerful impact of earlier EVT. These findings highlight the benefits of prehospital notification and direct triage to EVT centers with facilitated workflow on arrival by the MSU.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22653
DOI: 10.1161/STROKEAHA.119.027843
ORCID: 0000-0001-6324-3403
0000-0001-8162-682X
0000-0002-9807-6606
0000-0002-0776-1203
0000-0003-2475-9727
0000-0002-6614-8417
PubMed URL: 32078483
Type: Journal Article
Subjects: aged
hospitals
humans
stroke
workflow
Appears in Collections:Journal articles

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