Memorial Hermann-Texas Medical Center received a $6.8 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to continue to research mobile stroke unit (MSU) programs in the U.S.

“While it seems logical that this will result in better outcomes, the real question is how much better? That is why we have to do the study,” Dr. James Grotta, director of stroke research in the clinical innovation and research institute at the medical center, told HCB News.

For over two years, researchers at the medical center have been studying the outcomes of stroke patients in Houston who received care in the MSU. This funding will allow them to bring the MSU to additional neighborhoods in the Houston area, which will double the number of patients who can be treated.
The funding will also go toward patient-centered research at two MSU programs that will launch later this year in Denver, Colorado and Memphis, Tennessee. The award will span five years and within that time, the researchers plan to study the outcomes of about 700 patients.

“We now have very effective treatments that can improve outcomes for many stroke patients, but they depend on accurate diagnosis and are more effective the faster we can give them,” said Grotta. “The mobile stroke unit essentially 'takes the emergency department to the patient'.”

If ischemic stroke patients are given tissue plasminogen activator (tPA) within three hours of the first sign of stroke then the clots can usually be dissolved and blood flow to the brain can be restored. Preferably, the tPA should be given within the first hour of symptom onset to prevent long-term damage — but most patients receive it more than two hours after the onset of symptoms.

Having the CT, laboratory, and medical expertise on board the MSU allows the paramedics to diagnose and treat the patient at the scene, said Grotta.

“This should allow us to provide effective treatment much faster than if the patient had to first be transported to the emergency room of the hospital for diagnosis and treatment,” he added.

The MSU team is made up of a paramedic, nurse, CT technician, and a specially trained stroke neurologist, who either evaluates the patient at the scene or through telemedicine. The unit treats patients within an 8- to 10-mile radius of the medical center.

It operates on alternating weeks since the research needs to compare the outcomes for patients treated on the MSU and with standard treatment. Patients are traditionally transported by the fire department and treated in the emergency center and other stroke centers in the area.

The MSU was launched in June 2014 under the direction of Grotta and Memorial Hermann-TMC’s academic partners at McGovern Medical School. It has treated about 400 patients and about 40 percent of the patients received treatment within the first hour after the onset of stroke symptoms.

The results of this research will determine if the MSU strategy for administering acute stroke care can become the new standard for care across the country.

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