Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Thrombectomy Time Savings from Melbourne Mobile Stroke Unit Operation During COVID-19 Pandemic (#218)

Candice Menezes 1 2 , Ahmed Haliem 1 2 , Louise Weir 2 , Lauren Pesavento 2 , Leonid Churilov 2 3 4 5 , Dominic Italiano 1 , Gagan Sharma 6 7 , Prodipta Guha 6 , Geoffrey Donnan 2 8 , Stephen Davis 2 3 , Bruce Campbell 2 3 , Henry Zhao 2 3 , Karen Smith 9 , Belinda Delardes 9 , Skye Coote 6 , James Beharry 2 , Peter Mitchell 2 4 , Francesca Langenberg 6 , Cameron Williams 2
  1. Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  2. Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  4. Medicine, Austin Health, Melbourne, Victoria, Australia
  5. Medical school, University of Melbourne, Melbourne, Victoria, Australia
  6. Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  7. Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  8. Medicine, University of Melbourne, Melbourne, Victoria, Australia
  9. Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia

Background: Mobile Stroke Unit (MSU) operation globally has dramatically improved time to thrombolysis but uncertain impact on endovascular thrombectomy (EVT) times, especially with major workflow changes during the COVID-19 pandemic.

Aims: We examined the effect of the Melbourne MSU on time to thrombectomy pre- and post-pandemic onset in regard to patients within the catchment of a EVT-centre (who would normally present directly to the centre) and those outside (who require bypass to the EVT-centre). 

Methods: Patients receiving EVT facilitated by the Melbourne MSU from 2017-2022 were compared to non-MSU patients (metropolitan direct and secondary transfer for EVT) admitted to The Royal Melbourne Hospital. Quantile regression analysis was used to calculate median time differences (50th quantile).

Results: A total of 468 patients were included, with 134 MSU-facilitated patients. Pre-pandemic, no reduction in ambulance dispatch to arterial access time was seen for MSU patients within an EVT centre catchment (median 9 min slower, p=0.55). However, post-pandemic onset a significant time saving was observed (median 22 min faster, p=0.05, p-interaction=0.0462). MSU facilitation reduced hospital arrival to arterial access time by median 29 min pre-pandemic vs 56 min post-pandemic onset, p-interaction=0.058). The pandemic did not significantly alter MSU-related time savings for patients located outside of an EVT centre catchment (p-interaction>0.05).

Conclusion: Melbourne MSU operation during the COVID-19 pandemic significantly improved time to thrombectomy regardless of location within or outside an EVT-centre catchment. Slower in-hospital EVT workflows post-pandemic onset were likely mitigated by early identification on the MSU and pre-notification of the hospital EVT team.