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

Silke Walter; Heinrich J Audebert; Aristeidis H Katsanos; Karianne Larsen; Simona Sacco; Thorsten Steiner; Guillaume Turc; Georgios Tsivgoulis

doi:10.1177/23969873221079413

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

Eur Stroke J. 2022 Mar;7(1):XXVII-LIX. doi: 10.1177/23969873221079413. Epub 2022 Feb 9.

Authors

Silke Walter¹, Heinrich J Audebert^{2

3}, Aristeidis H Katsanos^{4

5}, Karianne Larsen^{6

7}, Simona Sacco⁸, Thorsten Steiner^{9

10}, Guillaume Turc^{11

12

13

14}, Georgios Tsivgoulis^{5

15}

Affiliations

¹ Department of Neurology, Saarland University Medical Centre, Homburg, Germany.
² Klinik und Hochschulambulanz für Neurologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
³ Center for Stroke Research Berlin Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
⁴ Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
⁵ Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁶ The Norwegian Air Ambulance Foundation, Oslo, Norway.
⁷ Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
⁸ Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
⁹ Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany.
¹⁰ Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
¹¹ Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Paris, France.
¹² Université de Paris, Paris, France.
¹³ INSERM U1266, Paris, France.
¹⁴ FHU Neurovasc, Paris, France.
¹⁵ Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.

Abstract

The safety and efficacy of mobile stroke units (MSUs) in prehospital stroke management has recently been investigated in different clinical studies. MSUs are ambulances equipped with a CT scanner, point-of-care lab, telemedicine and are staffed with a stroke specialised medical team. This European Stroke Organisation (ESO) guideline provides an up-to-date evidence-based recommendation to assist decision-makers in their choice on using MSUs for prehospital management of suspected stroke, which includes patients with acute ischaemic stroke (AIS), intracranial haemorrhage (ICH) and stroke mimics. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and aggregated data meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements are provided where sufficient evidence was not available to provide recommendations based on the GRADE approach. We found moderate evidence for suggesting MSU management for patients with suspected stroke. The patient group diagnosed with AIS shows an improvement of functional outcomes at 90 days, reduced onset to treatment times and increased proportion receiving IVT within 60 min from onset. MSU management might be beneficial for patients with ICH as MSU management was associated with a higher proportion of ICH patients being primarily transported to tertiary care stroke centres. No safety concerns (all-cause mortality, proportion of stroke mimics treated with IVT, symptomatic intracranial bleeding and major extracranial bleeding) could be identified for all patients managed with a MSU compared to conventional care. We suggest MSU management to improve prehospital management of suspected stroke patients.

Keywords: Mobile Stroke Unit; large vessel occlusion; prehospital; stroke; thrombolysis.