MedicalResearch.com Interview with:
Ken Uchino, MD FAHA FANA
Director, Vascular Neurology Fellowship
Research Director, Cerebrovascular Center, Cleveland Clinic
Associate Professor of Medicine (Neurology)
Lerner College of Medicine of CWRU
Cleveland, OH 44195
Medical Research: What is the background for this study? What are the main findings?
Dr. Uchino: Treatment for acute ischemic stroke is time dependent. Multiple studies have reported strategies to improve time to treatment after arrival in the hospital. Mimicking pre-hospital thrombolysis of acute myocardial infarction pioneered 30 years ago, two groups in Germany have implemented pre-hospital ischemic stroke thrombolysis using mobile stroke unit (“stroke ambulance”) that includes CT scan and laboratory capabilities. These units have been demonstrated to provide stroke treatment earlier than bringing patients to the emergency departments.
Our report extends the concept mobile stroke unit further by using telemedicine for remote physician presence. The other mobile stroke units were designed to have at least one physician on board. This allows potential multiple or geographically distant units to be supported by stroke specialists.
The study demonstrates that after patient arrival in the ambulance, the time to evaluation (CT scanning and blood testing) and to thrombolytic treatment is as quick or better as patient arrival in emergency department door. We are reporting the overall time efficiency after emergency medical service notification (911 call) in a separate paper.
Medical Research: What should clinicians and patients take away from your report?
Dr. Uchino: Mobile stroke units are operating in Cleveland and Houston and are being implemented other cities. Pre-hospital stroke care is changing by putting stroke specialist evaluation and stroke treatment before hospital arrival.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Uchino: Further research will clarify the long-term benefit improved outcome of ultra-early treatment with mobile stroke unit. There are other attempts, including enhanced evaluation or communication between prehospital providers and specialists to improve time efficiency. Various modes of evaluation need to be compared.
Ken Uchino (2015). Telemedicine Can Support Rapid Stroke Treatment in Ambulances