Rapid treatment of stroke with Mobile Stroke Unit

A Mobile Stroke Unit staffed with anesthesiologists trained in CT interpretation and pre-hospital clinical assessment, could reduced time to treatment for patients with acute stroke, according to Maren Ranhoff Hov’s PhD thesis.


MAIN RESULTS:

  1. The Mobile Stroke Unit model could rapidly diagnose patients with subarachnoid hemorrhage.
  2. With a CT scanner in the ambulance, anaesthesiologists can determine contraindications for thrombolysis.
  3. Stroke severity can be assessed in the Mobile Stroke Unit.

THESIS DEFENCE:

Thesis: Prehospital Assessment of Acute Stroke
Candidate: Maren Ranhoff Hov
Time: March 22, 2018 at 12:15
Place: Oslo University Hospital Ullevål: Red auditorium
Link to university website (in Norwegian)


SUMMARY:

(1) An eight-hour course was sufficient to teach experienced anaesthesiologists how to interpret CT scans of the brain. Following the course the doctors were highly capable of determining the patients with stroke who should not recieve thrombolysis.

(2) CT in the ambulance could be used by trained anaesthesiologists to confirm a diagnosis of subarachnoid hemorrhage and reduce time to neurosurgical care. A Mobile Stroke Unit model developed by The Norwegian Acute Stroke Pre-hospital Project has operated in the county of Østfold since 2014. Two of the patients transported by the unit had a diagnosis of subarachnoid hemorrhage confirmed by CT, and were transported directly to the regional neurosurgical department instead of the local hospital.

(3) The anaesthesiologists in the Mobile Stroke Unit could confirm contraindications for thrombolysis after just 10 minutes, more than half an hour before reaching the hospital. 13 doctors interpreted CT images from 51 patients, and the interpretations were similar to those of experienced radiologists at the hospital.

(4) Stroke severity was also precisely assessed in the Mobile Stroke Unit. The NIHSS scale is usually not used before arriving the hospital, but the score obtained in the Mobile Stroke Unit corresponded very well with hospital score in this study.


REFERENCES:

(1) Hov, M. R., Nome, T., Zakariassen, E., Russell, D., Røislien, J., Lossius, H. M., & Lund, C. G. (2015). Assessment of acute stroke cerebral CT examinations by anaesthesiologistsActa Anaesthesiologica Scandinavica59(9), 1179-1186.

(2) Hov, M. R., Ryen, A., Finsnes, K., Storflor, J., Lindner, T., Gleditsch, J., & Lund, C. G. (2017). Pre-hospital ct diagnosis of subarachnoid hemorrhageScandinavian journal of trauma, resuscitation and emergency medicine25(1), 21.

(3) Hov, M. R., Zakariassen, E., Lindner, T., Nome, T., Bache, K. G., Røislien, J., Gleditsch, J., Solyga, V., Russell, D., & Lund, C. G. (2018). Interpretation of brain CT Scans in the field by critical care physicians in a mobile stroke unitJournal of Neuroimaging28(1), 106-111.

(4) Hov, M. R., Røislien, J., Lindner, T., Zakariassen, E., Bache, K. C., Solyga, V. M., Russell, D., & Lund, C. G. (2017). Stroke severity quantification by critical care physicians in a mobile stroke unitEuropean journal of emergency medicine: official journal of the European Society for Emergency Medicine.