Background: Acute ischemic stroke is a treatable disease. Moreover, there is increasing evidence supporting mechanical recanalization for large-vessel occlusion, even beyond a strict time window. However, only small numbers of patients receive causal treatment.
Methods: One of the main reasons that patients do not receive causal therapy is their late arrival at the correct target hospital, which, depending on the type of stroke, is either a regional stroke unit or a comprehensive stroke center for interventional treatment. In order to triage patients correctly, a fast and complex diagnostic work-up is necessary, allowing a stroke specialist to decide on the best therapy option. As treatment possibilities become more comprehensive with the need for individualized decisions, the gap between treatment options and practical implementation is increasing.
Results: The "mobile stroke unit" concept encompasses the administration of prehospital acute stroke diagnostic work-up, therapy initiation, and triage to the correct hospital using a specially equipped ambulance, staffed with a team specialized in stroke. The concept, which was conceived and first put into practice in Homburg/Saar, Germany, in 2008, is currently spreading with more than 20 active mobile stroke unit centers worldwide. The use of mobile stroke units can reduce the time until stroke treatment by 50% with a tenfold increase of patients treated within the first 60 min of symptom onset.
Conclusion: The mobile stroke unit concept for acute stroke prehospital management is spreading worldwide. Intensive research is still needed to analyze the best setting for prehospital stroke management.
Keywords: Ambulance; Prehospital diagnosis; Thrombolytic therapy; Tissue plasminogen activator; Triage.