Ehntholt Mikel S, Parasram Melvin, Mir Saad A, Lerario Mackenzie P
Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
New York-Presbyterian Mobile Stroke Treatment Unit Program, New York, NY, USA.
Curr Treat Options Neurol. 2020 Feb 6;22(2):5. doi: 10.1007/s11940-020-0611-0.
Mobile stroke units (MSUs) have revolutionized emergency stroke care by delivering pre-hospital thrombolysis faster than conventional ambulance transport and in-hospital treatment. This review discusses the history of MSUs technological development, current operations and research, cost-effectiveness, and future directions.
Multiple prospective and retrospective studies have shown that MSUs deliver acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator (IV r-tPA) approximately 30 min faster than conventional care. The 90-day modified Rankin Scores for patients who received IV r-tPA on the MSU compared to conventional care were not statistically different in the PHANTOM-S study. Two German studies suggest that the MSU model is cost-effective by reducing disability and improving adjusted quality-life years post-stroke. The ongoing BEST-MSU trial will be the first multicenter, randomized controlled study that will shed light on MSUs' impact on long-term neurologic outcomes and cost-effectiveness. MSUs are effective in reducing treatment times in acute ischemic stroke without increasing adverse events. MSUs could potentially improve treatment times in large vessel occlusion and intracranial hemorrhage. Further studies are needed to assess functional outcomes and cost-effectiveness. Clinical trials are ongoing internationally.
移动卒中单元（MSU）通过比传统救护车转运和院内治疗更快地进行院前溶栓，彻底改变了急性卒中的急救护理。本综述讨论了移动卒中单元的技术发展历程、当前的运营与研究、成本效益以及未来发展方向。
多项前瞻性和回顾性研究表明，移动卒中单元使用静脉注射重组组织型纤溶酶原激活剂（IV r-tPA）治疗急性缺血性卒中的速度比传统治疗快约30分钟。在PHANTOM-S研究中，与传统治疗相比，在移动卒中单元接受IV r-tPA治疗的患者90天改良Rankin量表评分无统计学差异。两项德国研究表明，移动卒中单元模式通过减少残疾和改善卒中后调整质量生命年具有成本效益。正在进行的BEST-MSU试验将是第一项多中心随机对照研究，将阐明移动卒中单元对长期神经学结局和成本效益的影响。移动卒中单元在减少急性缺血性卒中治疗时间方面有效，且不会增加不良事件。移动卒中单元可能会改善大血管闭塞和颅内出血的治疗时间。需要进一步研究以评估功能结局和成本效益。国际上正在进行临床试验。
