Rescue Thrombolysis Or Hemorrhage Reversal In The Emergency Room After Transport By Mobile Stroke Treatment Unit

Introduction: Mobile Stroke Treatment Units (MSTU) can reduce time to pre-arrival intravenous thrombolysis (IVtPA) and reversal for intracerebral hemorrhage (ICH). We are reporting our experience as a comprehensive stroke center (CSC) receiving MSTU patients. Methods: We retrospectively reviewed consecutive patients transported by MSTU to our academic CSC from May 2019-May 2021 for suspected stroke. The Columbus MSTU is owned by a separate health system, but is a collaborative venture with 3 CSCs and Columbus Division of Fire, operating daily from 7am-7pm. Data was abstracted on demographics, clinical presentation, last known normal (LKN) time, initial National Institutes of Health Stroke Scale (NIHSS), neuroimaging, and IVtPA administration. Results: Among 144 patients transported to our CSC by MSTU, mean age was 66 years (range, 21-99) and 84 (88%) were female. Mean initial NIHSS was 8.6 (range, 0 to 32) and 84 (58.2%) had a final diagnosis of stroke. IVtPA was administered in 26 (18.1%) with a mean LKN to IVtPA time of 109 minutes (range, 41 to 243). Among 26 patients treated with IVtPA, 18 (69.2%) received IVtPA in MSTU and 8 (30.8%) received rescue IVtPA in CSC Emergency Room (ER). 14 patients underwent thrombectomy with median door-to-groin time of 63.5 minutes (range, 28 to 129). We identified 10 (6.9%) cases that received rescue thrombolysis or reversal for ICH after arrival to the CSC ER. Dispatch data was available in 7 of these patients. The median dispatch to on-scene time was 7 minutes (range, 5 to 17). Median dispatch to CSC ER arrival was 53 minutes (range, 40 to 88). Among patients who received rescue therapy in CSC ER, 8 received IVtPA and 2 received reversal for ICH (prothrombin complex concentrate for warfarin and cryoprecipitate/transhexamic acid for IVtPA). Among the 8 MSTU patients who received IVtPA in the CSC ER, reasons included clinical worsening en route (1), new collateral information obtained at the CSC ER (4), and other (3). Conclusion: In our series of suspected stroke patients evaluated by MSTU, 6.9% of the overall cases received rescue stroke treatment after arrival to the CSC ER. Among MSTU patients who received IVtPA, 30% had thrombolytic treatment after arrival to the CSC ER. Further studies are warranted to assess limitations of MSTU care.