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Time is truly of the essence when it comes to stroke care. The sooner a patient gets treatment, the more likely they are to receive medication that could help them recover more fully and live their lives without long-term disability.
The initiation of intravenous (IV) tissue plasminogen activator (tPA) to attempt to break up the blood clot increases recovery from stroke symptoms by up to 30%. But delay in presentation is the most common reason patients are ineligible for this life-saving treatment. It must be administered within a three-hour window and, currently, only 15% of stroke patients arrive in hospital early enough for this treatment.
If medics can go directly to the stroke patients, using connected care technology to facilitate the diagnosis scans and administer medication on the scene, there’s the potential for more stroke patients to have better outcomes.
Cleveland Clinic’s Mobile Stroke Unit aims to shorten the time between the onset of stroke-like symptoms and the delivery of these essential drugs. The stroke unit resembles a regular ambulance on the outside, but inside it contains highly specialized staff, equipment, and medication dedicated to diagnosing and treating strokes.
The unit, which comprises a paramedic, a critical care nurse, a CT technologist and an EMS driver, is integrated into the 911 dispatch system in the city of Cleveland.
The vehicle is equipped with a portable CT scanner that is capable of imaging the patient’s brain to detect the type of stroke they are experiencing.
Using connected care technology, the CT scans are wirelessly transmitted to Cleveland Clinic neuroradiologists, who analyze the CT scan for any signs of bleeding. This aids the team in determining if the patient is experiencing a stroke and, if so, whether it is ischemic (caused by a blood clot) or hemorrhagic (caused by a ruptured blood vessel).
Meanwhile, stroke neurologists access the patient’s symptoms via telemedicine technology at the scene.
A mobile lab can test blood samples on board.
If it is found that the patient is experiencing a blood clot-related stroke – which account for about 85% of all incidents – and meets criteria, the stroke unit’s medical team delivers a tPA through an IV in the arm. This helps break up the clot. In cases of hemorrhage, blood thinners can be reversed and blood pressure controlled. After determining and receiving appropriate treatment, the patient is then transported to the closest Primary or Comprehensive Stroke Center, depending on their needs.
The Cleveland Clinic Pre-Hospital Acute Stroke Treatment (PHAST) study group analyzed the first 100 patients treated on the mobiles stroke unit compared to traditional care delivery, and showed a reduction in alarm to treatment time of 38 minutes, with an IV tPA utilization rate of 48%. These times are among the fastest published times in the world.
At the Cleveland Clinic, which treats more than 3,000 individuals on an in-patient basis every year, the mobile stoke unit has dramatically increased the proportion of stroke victims that get speedy access to tPA. And, with only 8.5% of potentially eligible patients across the US currently receiving a tPA, Cleveland could be building a model for the whole country to follow.
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