"Mobile Stroke-Unit" for Reduction of the Response Time in Ischemic Stroke (MSU)

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

Stroke, the most common cause of permanent disability, the second most common cause of dementia and third most common cause of death, has tremendous socio-economic consequences.

Currently, systemic thrombolysis with the tissue plasminogen activator represents the only causal and approved treatment for acute ischemic stroke. However, the chances to save the brain tissue by a thrombolytic therapy exponentially decrease with proceeding time after onset of symptoms.

In most cases, the beginning of the thrombolysis therapy is delayed by a variety of factors, like delivery to the hospital, re-examinations and delay of blood analysis or of CT scans. Due to this, a thrombolytic therapy is possible only in a minority of the stroke patients (2-5 %). The aim of this study is to investigate whether a "Mobile Stroke Unit", a rescue car with an integrated CT scanner, necessary for essential diagnostics, contributes to a better stroke management by saving precious time until a therapeutic decision is made. The trial is planned as a monocentric, randomised prospective trial.

Condition or disease	Intervention/treatment	Phase
Stroke	Procedure: MSU; Procedure: OCCM	Not Applicable

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Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	200 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Health Services Research
Official Title:	"Mobile Stroke-Unit" for Reduction of the Response Time in Ischemic Stroke
Study Start Date :	November 2008
Actual Primary Completion Date :	July 2011
Actual Study Completion Date :	July 2011

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: MSU	Procedure: MSU; In the "Mobile Stroke Unit" procedure: Conventional Emergency Medical Service together with the MSU will meet at the side, where the patient is found. The MSU is an ambulance, equipped with a neurologist and neuroradiologist and includes CT scanner and point of care laboratory unit. The patient's medical history and the physical examination will be directly performed by the neurologist. CT scan analysis will be performed by the neuroradiologist, while the neurologist will analyze the blood samples with the point of care laboratory unit. If the inclusion and exclusion criteria are fulfilled, the thrombolytic therapy will directly be started by the neurologist. A possible thrombolytic therapy will be performed under the current inclusion and exclusion criteria that are associated with the rt-PA drug approval in Europe. After performance of the acute therapy, the patient will be transported to the University Hospital of the Saarland.
Active Comparator: OCCM	Procedure: OCCM; In the optimized conventional clinical management: After patient's medical history, physical examination and emergency treatment by the emergency physician, the patient will be transported to the University Hospital of the Saarland. The delivery of the patient will directly take place at the CT scanner. The neurologist will perform a second medical history, physical examination, while the blood will be drawn by the assisting nurse. CT scan will be performed, while the blood will be analyzed by point of care technique, placed close to the CT scanner. Additionally the blood will be sent in parallel to the hospital central laboratory for conventional laboratory analysis. Depending on the results, a thrombolytic therapy will be initiated directly at the CT. Thereafter, the patient will be transported to the hospital Stroke Unit.

Outcome Measures

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Primary Outcome Measures :

1. Time between emergency call and therapy decision

Secondary Outcome Measures :

1. Time between emergency call and end of CT, end of blood analysis, start of thrombolysis; time between symptoms and end of CT, end of blood analysis, therapy decision, number of patients with thrombolysis, start of thrombolysis, functional status

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 80 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Age between 18 and 80 years
• Onset of symptoms until call at least 30 min prior to the end of the approved time window for thrombolysis (and not after awakening)
• Clinical signs of ischemic stroke with suddenly occurring, measurable neurological deficits defined as impairment of language, motor function, facial palsy or asymmetry
• Patient is willing to participate voluntarily and to sign a written informed consent. Informed consent will be obtained from each patient or the subject's legally authorized representative or relative.
• Patients who are unable to sign but who are able to understand the meaning of participation in the study may give an oral witnessed informed consent. These patients have to make undoubtfully clear that they are willing to participate voluntarily and must be able to understand an explanation of the contents of the information sheet.

Exclusion Criteria:

• Age younger than 18 or older than 80 years
• Non-acute onset of symptoms
• No focal stroke-like symptoms
• Pregnant patients

Contacts and Locations

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Locations

Germany
Department of Neurology, University Hospital of the Saarland
Homburg/Saar, Saarland, Germany, 66424

Sponsors and Collaborators

University Hospital, Saarland

German Red Cross

Meytec Information Systems GmbH, Werneuchen

Else Kröner Fresenius Foundation

Mercedes-Benz AG, Niederlassung Saarbrücken

Stadt Homburg

Rettungsstiftung Saarland

Rettungsdienst Logistik-Service GmbH, Saarland

Investigators

Principal Investigator:	Klaus C Fassbender, Prof. Dr.	Neurology, University Hospital of the Saarland, Germany

More Information

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Additional Information:

Department Homepage and reference to the project 

Publications:

Fassbender K, Walter S, Liu Y, Muehlhauser F, Ragoschke A, Kuehl S, Mielke O. "Mobile stroke unit" for hyperacute stroke treatment. Stroke. 2003 Jun;34(6):e44. Epub 2003 May 15.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T, Roth C, Papanagiotou P, Grunwald I, Schumacher H, Helwig S, Viera J, Körner H, Alexandrou M, Yilmaz U, Ziegler K, Schmidt K, Dabew R, Kubulus D, Liu Y, Volk T, Kronfeld K, Ruckes C, Bertsch T, Reith W, Fassbender K. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012 May;11(5):397-404. doi: 10.1016/S1474-4422(12)70057-1. Epub 2012 Apr 11. Erratum in: Lancet Neurol. 2012 Jun;11(6):483.

Responsible Party:	Prof. Dr. med. Klaus Fassbender, University Hospital of the Saarland, Department of Neurology
ClinicalTrials.gov Identifier:	NCT00792220 History of Changes
Other Study ID Numbers:	MSU
First Posted:	November 17, 2008
Last Update Posted:	June 2, 2015
Last Verified:	May 2015

Keywords provided by University Hospital, Saarland:

stroke; mobile stroke unit; thrombolysis; stroke management; computerized tomography

Additional relevant MeSH terms:

Stroke; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases	Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases