Lessons Learned From Cleveland Clinic’s Mobile Stroke Unit: Blake Buletko, MD

WATCH TIME: 4 minutes

"We have to make it [the service] worthwhile. This involves training up crews. This crew—not just the unit itself—is a very specialized crew that predominantly does mobile stroke unit. They are very on top of things and they make the whole unit go. How do we keep the crews excited? Involved?"

Mobile stroke units (MSUs) are specialized ambulances equipped with the personnel, equipment, and imaging capability to diagnose and treat acute stroke in the prehospital setting. These tailored ambulances were first developed in Saarland, Germany, in 2008, with the expectation that bringing a stroke units would lead to quicker thrombolysis times, thereby improving stroke outcomes. Years later, in 2014, Cleveland Clinic became the 4th institution in the world and 2nd in the United States to start an MSU for prehospital stroke treatment.

While there has been a growing body of literature surrounding MSUs and acute ischemic stroke, literature describing the intracerebral hemorrhage experience in MSUs has been lacking. To address these concerns, researchers at Cleveland Clinic conducted a study comparing treatment outcomes of those with intracerebral hemorrhage who were triaged by MSU (n = 146) or emergency medical services (n = 221). Presented at the 2024 International Stroke Conference (ISC), held February 7-9, in Phoenix, Arizona, results showed that Times from door to CT completion (14 vs 33 min, p=0.000), anticoagulation reversal (99 vs 139 min, p=0.013), anti-hypertensive medication administration (21 vs 45 min, p=0.020), and goal blood pressure (35 vs 51 min, p=0.000) were significantly faster in the MSU cohort.

Following the presentation, lead investigator Blake Buletko, MD, sat down with NeurologyLive^® to provide perspective on the lessons learned within the Cleveland Clinic MSU as it approaches 10 years since inception. Buletko, a vascular neurologist and director of the residency program at Cleveland Clinic, discussed the questions he and his colleagues face when trying to optimize this type of prehospital care, as well as whether MSUs can be used for other types of stroke outside of ischemic and intracerebral hemorrhage. Furthermore, he also gave thoughts on the frequency of mimic conditions that look like stroke and how the team approaches each situation.

Click here for more coverage of ISC 2024.

REFERENCE
1. Zhang A, Askari E, Huang M, et al. Mobile stroke units enable hyperacute interventions for intracerebral hemorrhage. Presented at: International Stroke Conference; February 7-9, 2024; Abstract WMP78