A research team at Memorial Hermann-Texas Medical Center (TMC) has been approved for a $6.8 million funding award to expand its study of Mobile Stroke Unit (MSU) programs across the country by the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit organization authorized by Congress in 2010.
For more than two years, researchers have been studying the outcomes of Houston stroke patients transported aboard a Mobile Stroke Unit that operates under Memorial Hermann’s Life Flight ambulance service and was originally purchased by McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). The special ambulance, which was the first of its kind in the nation, comes equipped with a CT (computed tomography) scanner and has the capability to begin administering effective stroke treatments immediately after the stroke is discovered and before patients are taken to the hospital.
The additional funding from PCORI will allow researchers to expand the study by extending MSU operations into additional neighborhoods in the Houston area, doubling the number of local patients who can be treated.
In addition, the funding will help support patient-centered research at two MSU programs that are launching later this year in Denver, Colorado and Memphis, Tennessee. Under the five-year funding award from PCORI, researchers plan to study outcomes of approximately 700 patients in Houston and the other two locations.
“This generous funding award from PCORI allows us to embark on the second phase of our research journey,” said Dr. James Grotta, recipient of the funding award who is also director of stroke research in the Clinical Innovation & Research Institute at Memorial Hermann-TMC and director of the MSU Consortium. The consortium is a collaboration among Memorial Hermann-TMC, McGovern Medical School at UTHealth and other community stakeholders including all comprehensive stroke centers in the Texas Medical Center, the City of Houston Fire Department’s Emergency Medical Services, Bellaire and West University Fire Departments, and patient representatives.
“By expanding operations in the Houston area and helping fund research on stroke units in different regions, our research team will be able to gather data about the MSU’s impact on patient outcomes, critical information as these units continue to gain in popularity,” Dr. Grotta said. “The successful completion of this trial will determine if the MSU strategy for delivering acute stroke care can become the new standard of care across the nation.”
Stroke is a leading cause of serious, long-term disability in the United States. Tissue plasminogen activator (tPA) is a very effective treatment for dissolving clots and restoring blood flow to the brain for patients having an ischemic stroke. However, the drug must be given within three hours of the first sign of a stroke to be most effective, and preferably within the first hour of symptom onset to prevent severe long-term damage.
Despite these statistics, the average time of tPA administration for most stroke patients nationwide is more than two hours after symptoms begin, according to Dr. Grotta. The MSU is dispatched in collaboration with fire department ambulances and, once on scene, the team on board determines if the patient is having a stroke. If so, they deliver stroke care immediately while en route to the hospital, dramatically cutting patients’ time to treatment in a move that could reduce their risk of long-term disabilities and improve their quality of life.
“Accelerating a stroke patient’s access to treatment is critical because millions of brain cells die every minute following the onset of stroke symptoms,” Dr. Grotta said. “What we are hoping to learn is whether speedier treatment via the Mobile Stroke Unit makes a significant difference in outcomes that are important to patients such as reduction in costly and life-altering disabilities.”
Until now, the MSU has been solely funded by donations and a grant from the American Heart Association. The MSU team includes a paramedic, nurse, CT technician, and a specially trained stroke neurologist, who evaluates the patient either directly on board the MSU or remotely via telemedicine. The unit is dispatched and treats patients within an 8- to 10-mile radius of the Texas Medical Center. It operates on alternating weeks since the research requires comparing outcomes for patients treated on the MSU versus standard treatment when they are transported by the fire department and managed in the emergency centers of Memorial Hermann-TMC and other stroke centers within the same catchment area.
Research has shown that half of patients treated with tPA within the first hour after onset of stroke symptoms will recover with little or no lingering physical disabilities or speech deficits, which means quick and aggressive stroke treatment during that “golden hour” can improve survivability and reduce risks of long-term complications. Still, fewer than 5 percent of all ischemic stroke patients in the U.S. are treated with tPA, according to Dr. Grotta, and only one in 2,000 stroke patients receive tPA within the “golden hour,” he said.
Since its launch in June 2014 under the direction of Dr. Grotta and Memorial Hermann-TMC’s academic partners at McGovern Medical School, the MSU has treated approximately 400 patients, including administering tPA to more than half. About 40 percent of MSU patients receive treatment within the first 60 minutes after their stroke symptoms begin, much greater than the national average. The unit remains one of the largest administrators of tPA in the Houston region, according to Dr. Grotta.
The MSU was selected for funding by PCORI following a highly competitive review process in which patients, clinicians and other stakeholders evaluate the proposals along with clinical scientists. The funding award for the MSU has been approved pending completion of a business and programmatic review by PCORI staff and the issuance of a formal contract award. PCORI funds research that provides patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions.