TMC PULSE

t m c » p u l s e | j u ly 2 0 1 4 35 Nation's First Mobile Stroke Unit Successfully Transports First Patient T he University of Texas Health Science Center at Houston (UTHealth) Medical School, in partner- ship with Memorial Hermann-Texas Medical Center (TMC), announced that the UTHealth Mobile Stroke Unit had successfully transported and helped save the life of its first patient. The unit, which is the first and only of its kind in the nation treating patients, is a specially-equipped ambu- lance with a CT (computed tomogra- phy) scanner that allows a stroke unit team member to quickly assess whether a patient is having a stroke caused by a blood clot and, if so, the clot-buster tPA (tissue plasminogen activator) can be administered. Since becoming fully licensed and ready to go live late last month, the unit was dispatched for the first time to 30-year-old Maureen Osaka's home near downtown Houston after 911 received a call from Osaka's friend that the woman was suffering from stroke- like symptoms. "I felt so weak, I couldn't use my hand and I was so dizzy," said Osaka. "I couldn't stand up so I started crawling from the living room to my bedroom, thinking I was going to lie down and go to sleep to hopefully feel better—I didn't know what was going on. But before I could make it to my room, the whole left side of my body stopped working and I could no longer see, so I made it to the phone and blindly started dialing the only numbers I knew." Upon arrival, the mobile stroke unit team assessed Osaka then moved her into the ambulance where they immedi- ately started the CT scan. Within min- utes, they were able to confirm Osaka was not only suffering a stroke but probably had one of the rarest and most fatal types of stroke, a basilar artery occlusion, which means the blood clot was blocking an artery that provides blood to the brain stem. Having the critical information they needed from the scan, the team was able to begin administering tPA treatment on site, before the ambulance even left the scene for the Comprehensive Stroke Center at the Mischer Neuroscience Institute at Memorial Hermann-TMC. "The type of stroke that Ms. Osaka suffered is often difficult to diagnose, so in addition to speeding treatment, the Mobile Stroke Unit brings specialized stroke expertise right to the patient's home at a time when it is needed most," said James C. Grotta, M.D., the neurologist who led the team that treated Osaka that day. "tPA is the only FDA-approved treatment for an ischemic stroke, but it must be given within three hours of the first signs of stroke to be most effec- tive," added Grotta, who is also direc- tor of stroke research in the Clinical Institute for Research & Innovation at Memorial Hermann-TMC and director of the mobile stroke unit consortium that will also include the stroke teams from Houston Methodist Hospital and CHI St. Luke's Health-Baylor St. Luke's Medical Center, local businesses and philanthropists. "It typically takes an hour once a stroke patient arrives in the emergency room to receive treatment, and that's not counting transport time. In these situations, every minute— every second—counts, so the earlier the clinical team can intervene, the better the outcome." "Ms. Osaka was treated approxi- mately 78 minutes after she first felt sick. Fewer than one percent of all stroke patients are treated that quickly. When she first arrived at the Memorial Hermann-TMC Emergency Center, her basilar artery was still blocked, but by the time the team got her up to the endovascular suite to try to extract the clot, it had already largely dissolved," said Grotta. Mark Dannenbaum, M.D., neurosur- geon with the Mischer Neuroscience Institute at Memorial Hermann-TMC and associate professor in the depart- ment of neurosurgery at UTHealth, performed the endovascular procedure to remove the rest of the blood clot from her brain. Patients with an acute basilar artery occlusion, the type of stroke that Osaka suffered, typically have a mortality rate of greater than 85 percent. Those who survive are often left partially paralyzed or otherwise severely disabled, whether mentally, physically or both. But just days after her stroke, Osaka was moving her left side, speaking clearly and walking independently. "I remember being in the ambu- lance on the way to the hospital and thinking I'd never be able to use my hand again. I'll never talk again. I'd lost all hope," said Osaka. "But I can still talk! In just one day, I went from not being able to speak, to speaking but no one could understand me, to now speak- ing and pronouncing things perfectly. Before the end of that same day, I could also move my hand again. It was like a dream! I could even stand up and walk!" "Now that we quite literally have a mobile emergency room in the ambu- lance, we are able to assess and treat the patient faster than ever before possible," said Stephanie Parker, R.N., BSN, project manager for the UTHealth Mobile Stroke Unit. "Because we were able to arrive so quickly and initiate tPA treatment on scene, we may have not only saved Ms. Osaka's life, but by cutting down on precious time, we were able to help save millions of her brain cells and minimize any residual disabil- ity as well." Osaka, who is originally from Nigeria but travels the world doing philanthropic work, feels blessed and thankful that she happened to be in Houston and within the unit's response radius when her stroke occurred. — Kathryn Klein, Memorial Hermann— Texas Medical Center Now that we quite literally have a mobile emergency room in the ambulance, we are able to assess and treat the patient faster than ever before possible. — STEPHANIE PARKER, R.N., BSN Project Manager for the UTHealth Mobile Stroke Unit

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