Interpretation of European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

doi:10.3877/cma.j.issn.2095-123X.2023.01.002

Abstract

Abstract:

Stroke has become a major nervous system disease that endangers human health. The key to cure is to solve the "bottleneck" problem of immediate diagnosis and treatment within the "1 h golden time" . In 2022, the "European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management" was published, which is the first mobile stroke unit (MSU) prehospital stroke management guide in the world. Guideline recommendations: For patients with confirmed acute ischemic stroke, using MSU for prehospital management can improve their clinical function, increase the rate of IVT treatment, and shorten the time to start thrombolytic therapy. For patients with intracranial hemorrhage, using MSU for prehospital management can increase the proportion of patients directly assigned to tertiary medical stroke centers without concern about short-term mortality. No relevant safety concerns were identified with MSU management in suspected stroke patients. This article will interpret this guideline to better guide clinical practice.

Key words: Stroke, Guideline interpretation, Mobile stroke unit, Prehospital treatment and management

Ruxiang Xu. Interpretation of European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(01): 5-33.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhnkjbykfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-123X.2023.01.002

https://zhnkjbykfzz.cma-cmc.com.cn/EN/Y2023/V13/I01/5

References 17

[1]	Tsivgoulis G, Katsanos AH, Kadlecová P, et al. Intravenous thrombolysis for ischemic stroke in the golden hour: propensity-matched analysis from the SITS-EAST registry[J]. J Neurol, 2017, 264(5): 912-920. DOI: 10.1007/s00415-017-8461-8.
[2]	Kim JT, Fonarow GC, Smith EE, et al. Treatment with tissue plasminogen activator in the golden hour and the shape of the 4.5-hour time-benefit curve in the national United States get with the guidelines-stroke population[J]. Circulation, 2017, 135(2): 128-139. DOI: 10.1161/CIRCULATIONAHA.116.023336.
[3]	Fassbender K, Walter S, Liu Y, et al. "Mobile stroke unit" for hyperacute stroke treatment[J]. Stroke, 2003, 34(6): e44. DOI: 10.1161/01.STR.0000075573.22885.3B.
[4]	Ebinger M, Siegerink B, Kunz A, et al. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin[J]. JAMA, 2021, 325(5): 454-466. DOI: 10.1001/jama.2020.26345.
[5]	Grotta JC, Yamal JM, Parker SA, et al. Prospective, multicenter, controlled trial of mobile stroke units[J]. N Engl J Med, 2021, 385(11): 971-981. DOI: 10.1056/NEJMoa2103879.
[6]	Turc G, Hadziahmetovic M, Walter S, et al. Comparison of mobile stroke unit with usual care for acute ischemic stroke management: a systematic review and meta-analysis[J]. JAMA Neurol, 2022, 79(3): 281-290. DOI: 10.1001/jamaneurol.2021.5321.
[7]	Steiner T, Dichgans M, Norrving B, et al. European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines[J]. Eur Stroke J, 2021, 6(3): CXXII-CXXXIV. DOI: 10.1177/23969873211024143.
[8]	Ebinger M, Winter B, Wendt M, et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial[J]. JAMA, 2014, 311(16): 1622-1631. DOI: 10.1001/jama.2014.2850.
[9]	Helwig SA, Ragoschke-Schumm A, Schwindling L, et al. Prehospital stroke management optimized by use of clinical scoring vs mobile stroke unit for triage of patients with stroke: a randomized clinical trial[J]. JAMA Neurol, 2019, 76(12): 1484-1492. DOI: 10.1001/jamaneurol.2019.2829.
[10]	Walter S, Kostopoulos P, Haass A, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial[J]. Lancet Neurol, 2012, 11(5): 397-404. DOI: 10.1016/S1474-4422(12)70057-1.
[11]	Larsen K, Jaeger HS, Tveit LH, et al. Ultraearly thrombolysis by an anesthesiologist in a mobile stroke unit: a prospective, controlled intervention study[J]. Eur J Neurol, 2021, 28(8): 2488-2496. DOI: 10.1111/ene.14877.
[12]	Weber JE, Ebinger M, Rozanski M, et al. Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study[J]. Neurology, 2013, 80(2): 163-168. DOI: 10.1212/WNL.0b013e31827b90e5.
[13]	Ebinger M, Kunz A, Wendt M, et al. Effects of golden hour thrombolysis: a prehospital acute neurological treatment and optimization of medical care in stroke (PHANTOM-S) substudy[J]. JAMA Neurol, 2015, 72(1): 25-30. DOI: 10.1001/jamaneurol.2014.3188.
[14]	Kunz A, Ebinger M, Geisler F, et al. Functional outcomes of prehospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study[J]. Lancet Neurol, 2016, 15(10): 1035-1043. DOI: 10.1016/S1474-4422(16)30129-6.
[15]	Nolte CH, Ebinger M, Scheitz JF, et al. Effects of prehospital thrombolysis in stroke patients with prestroke dependency[J]. Stroke, 2018, 49(3): 646-651. DOI: 10.1161/STROKEAHA.117.019060.
[16]	Kummer BR, Lerario MP, Hunter MD, et al. Geographic analysis of mobile stroke unit treatment in a dense urban area: the New York City METRONOME registry[J]. J Am Heart Assoc, 2019, 8(24): e013529. DOI: 10.1161/JAHA.119.013529.
[17]	Wendt M, Ebinger M, Kunz A, et al. Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study[J]. Stroke, 2015, 46(3): 740-745. DOI: 10.1161/STROKEAHA.114.008159.

Please choose a citation manager

Content to export