The University of Texas Health Science Center at Houston (UTHealth) Medical School, in partnership with Memorial Hermann-Texas Medical Center (TMC), USA, has announced that the UTHealth Mobile Stroke Unit has successfully transported and helped save the life of its very first patient.
The unit, which is the first and only of its kind in the nation treating patients, is a specially-equipped ambulance with a CT (computed tomography) scanner that allows a stroke unit team member to quickly assess whether a patient is having a stroke caused by a blood clot and, if so, the clot-buster tPA (tissue plasminogen activator) can be administered.
Since becoming fully licensed and ready to go live late last month, the unit was dispatched for the very first time to 30-year-old Maureen Osaka’s home near downtown Houston after 911 received a call from Osaka’s friend that the woman was suffering from stroke-like symptoms.
Upon arrival, the mobile stroke unit team assessed Osaka then moved her into the ambulance where they immediately started the CT scan. Within minutes, they were able to confirm Osaka was not only suffering a stroke but probably had one of the rarest and most fatal types of stroke, a basilar artery occlusion, which means the blood clot was blocking an artery that provides blood to the brain stem.
Having the critical information they needed from the scan, the team was able to begin administering tPA treatment on site, before the ambulance even left the scene for the Comprehensive Stroke Center at the Mischer Neuroscience Institute at Memorial Hermann-TMC. “The type of stroke that Osaka suffered is often difficult to diagnose, so in addition to speeding treatment, the Mobile Stroke Unit brings specialised stroke expertise right to the patient’s home at a time when it is needed most,” says James C Grotta, the neurologist who led the team that treated Osaka that day.
“Tissue plasminogen activator is the only FDA-approved treatment for an ischaemic stroke, but it must be given within three hours of the first signs of stroke to be most effective,” adds Grotta, who is also director of stroke research in the Clinical Institute for Research & Innovation at Memorial Hermann-TMC and director of the mobile stroke unit consortium that will also include the stroke teams from Houston Methodist Hospital and St. Luke’s Medical Center, local businesses and philanthropists. “It typically takes an hour once a stroke patient arrives in the emergency room to receive treatment, and that’s not counting transport time. In these situations, every minute – every second – counts, so the earlier the clinical team can intervene, the better the outcome.”
“Osaka was treated approximately 78 minutes after she first felt sick. Fewer than 1% of all stroke patients are treated that quickly. When she first arrived at the Memorial Hermann-TMC Emergency Center, her basilar artery was still blocked, but by the time the team got her up to the endovascular suite to try to extract the clot, it had already largely dissolved,” explains Grotta.
The stroke unit is run in conjunction with the Emergency Medical Services of the Houston Fire Department, Bellaire Fire Department and West University Fire Department. It carries a paramedic, neurologist, nurse and CT technician and runs alternate weeks as part of a clinical trial at UTHealth. The trial, which is expected to last three years, includes the telemedicine program that is part of UTHealth and the Mischer Neuroscience Institute at Memorial Hermann-TMC. Researchers are looking at whether the telemedicine programme, which physicians across the state use to consult with UTHealth stroke experts affiliated with Memorial Hermann-TMC, can be applied to the mobile stroke unit. If so, the unit might be able to respond to calls in the future using telemedicine, which could make it more cost effective.