Optimizing Mobile Stroke Units and Dealing With Associated Costs: Gregory W. Albers, MD

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“MSUs are very expensive. They require a lot of effort to keep them up and running, so most communities don’t have them available. But, if it is available, it clearly makes a difference because you can get the thrombolytic—tPA or TNK—started out in the field.”

Mobile stroke units (MSUs) have become a major topic of discussion in the stroke and cerebrovascular disease field, mainly because recent literature has pointed to their effectiveness in improving patient outcomes by allowing for quicker time to treatment initiation. Perhaps the best such example of this was the BEST-MSU study (NCT02190500) by Grotta et al, which suggests that in patients with acute stroke who were eligible for tissue plasminogen activator (tPA), utility-weighted disability outcomes at 90 days were better with MSUs than with standard emergency medical services (EMS) care.¹

Although, there are challenges to implementing these units nationwide. The first major barrier is the necessary costs to operate them­­. Currently, many of the cities with MSUs in operation are able to sustain their use via philanthropy from large medical institutions or individual donors, making access for many smaller communities difficult. Another facet driving up costs are the imaging requirements for the units, which can be offset somewhat by including automated imaging technology, or even telemedicine technology to save the cost of a neurologist riding on-board. Despite these efforts, though, the use of MSUs nationwide is still relatively low.

Gregory W. Albers, MD, director, Stanford Stroke Center, and Coyote Foundation Professor of Neurology and Neurological Sciences, Stanford Medical Center, and founder, RapidAI, has had firsthand experience with MSUs and the technologies they utilize. In a conversation with NeurologyLive^®, he shared his expertise and perspective on how to potentially address some of these difficulties, and spoke about their potential to offer paradigm-shifting care.

REFERENCE
1. Grotta JC, Yamal J-M, Parker SA, et al. Prospective, Multicenter, Controlled Trial of Mobile Stroke Units. N Engl J Med. 2021;385:971-981. doi:10.1056/NEJMoa2103879