Use of portable stroke units linked to improved clinical outcomes

STEMOs (Stroke-Einsatz-Mobile) have been serving Berlin for ten years. The special stroke emergency response vehicles allow physicians to begin treating patients with stroke before they arrive at the hospital. For the first time, a team of researchers from Charité – Universitätsmedizin Berlin has been able to show that the proliferation of mobile stroke units is associated with better clinical outcomes. The researchers’ findings, which show that patients with STEMOs who were discharged were more likely to live without a long-term disability, were published in JAMA.

The phrase ‘time is brain’ emphasizes a basic principle of emergency medicine, which is that after a stroke, every minute counts. Without treatment, the brain loses two million brain cells per minute. When dealing with a stroke caused by an arterial obstruction in the brain, rapid release of the blood clot – called thrombolysis – is essential.

Ten years ago, a team led by Prof. Dr. Heinrich Audebert (Berlin Center for Stroke Research (CSB) and Charité Department of Neurology and Experimental Neurology) aims to further reduce time to treatment by giving the patient the necessary diagnostic and treatment methods rather than the other way around.

They did so with great success: the first purpose-built mobile stroke unit in Berlin, developed in partnership with the Berlin Fire Department and MEYTEC GmbH, was launched in February 2011. After years of research, the team was able to confirm that STEMO-based strokes are safe to treat and, more importantly, reduce time to treatment.

Today, the Berlin Fire Department operates three STEMO vehicles. As part of a collaboration between Charité, Vivantes – Netzwerk für Gesundheit GmbH and Unfallkrankenhaus Berlin, these vehicles cover most of the Berlin area. Data from a now-published B_PROUD study show that the proliferation of STEMO mobile stroke units is associated with better outcomes in patients with stroke.

In our study, the removal of a mobile stroke unit was associated with increased survival and a lower risk of disability. The odd numbers of those patients with major disabilities three months after a stroke were 29 percent lower than in patients cared for by the emergency medical services. Thus the spread of STEMO leads to many more stroke patients returning to independent living after a stroke. “

Prof. Dr. Heinrich Audebert, Berlin Stroke Research Center (CSB) and Charité Department of Neurology and Experimental Neurology

A selection of voices and ideas on the STEMO initiative – from Michael Müller (Mayor of the Berlin Government and Senator for Higher Education and Research), Prof. Dr. Heyo K. Kroemer (Chief Executive Officer of Charité), as well as the participants of the campaign. and other supporters – available here.

Under the direction of Professor Audebert and the first author of the study, Dr. Dr. Martin Ebinger (Medical Director of Humboldtmühle Park Medical Rehabilitation Hospital), the team investigated cases of stroke crisis that occurred in Berlin between February 2017 and May 2019. Whether a STEMO mobile stroke unit was effectively disposed of by decision by chance: if one was available within the relevant area, it was dispatched at the same time as the vehicle -conventional care, allowing the patient to receive treatment before arriving at the hospital.

STEMO mobile stroke unit was discharged in 749 of a total of 1,543 cases examined as part of the study (49 percent). If STEMO was not available at the time of the emergency call, only a conventional ambulance was dispatched to ensure transportation to a specialized hospital. In 794 cases (51 percent), patients were receiving care within the standard emergency medical system. Using a standard protocol, the researchers then determined survival at three months after stroke and the degree of neurological impairment affecting the patients.

Results from their comparison between the STEMO and the control groups were clear. Not only did a greater number of STEMO patients receive thrombolysis (60 percent versus 48 percent in the control group), they received this treatment on average 20 minutes earlier than controls. After three months, approximately 7 percent of patients in the STEMO septic group had died. This figure was compared to 9 percent in the typical ambulance group.

Similarly, while about 51 percent of patients in the STEMO group reported no stroke-related deficiencies in daily work, the corresponding figure in the control group was only 42 percent. Patients in the STEMO group also scored significantly better on quality-of-life measures.