In-hospital death rates in confirmed stroke cases were 4.4% for the STEMO in-service weeks (3.8% if the unit was actually deployed) and 4.5% for control weeks.
In TPA-treated patients, there was a nonsignificant trend toward fewer patients having intracranial hemorrhage if TPA was delivered in the STEMO unit, at 3.5%, compared with the overall rates during STEMO-serviced weeks (4.8%) and control weeks (6.0%).
"The current response time is about 16 minutes," coinvestigator Dr. Martin Ebinger, also of Charité-Universitätsmedizin Berlin, commented at a press briefing.
"Sometimes there were multiple, simultaneous calls," he said, noting that, at the current time, there is only one STEMO vehicle. If there were two mobile stroke units, then of course more people in the catchment area could be reached, and the response time could maybe even be halved to 8 minutes.
"We really need a very good, independent cost-effectiveness analysis," Dr. Ebinger conceded. Discussions with patient insurance groups and politicians have been started to determine how best to conduct such an analysis.
Dr. Michael Hennerici, professor of neurology at the University of Heidelberg in Germany, commented at the press briefing that giving thrombolysis to patients who have had a stroke is perhaps more complex than giving it to those who have had a heart attack. There are many different types of stroke, and only a selected population may require thrombolysis, he observed.
Dr. Martin Brown, professor of stroke medicine at University College London, also gave his thoughts on the data in an interview. "It certainly makes sense to get the treatment to patients as quickly as possible, but we need a CT scan of every patient before we give the treatment," he said.
Dr. Martin Ebinger
"The real question is, however, ‘Is it more efficient to work on getting the patient to hospital as quickly as possible, or if we should be working on this model and trying to get money for more expensive ambulances?" Dr. Brown added.
"What we really need to know is what difference an extra 25 minutes means in terms of the number of patients that gain benefit. If it is only a small proportion, it might not be cost-effective," Dr. Brown said.
The STEMO project is a collaboration between Charité-Universitätsmedizin Berlin, the Berlin Fire Department, Brahms GmbH, and MEYTEC GmbH. It is cofunded by Technology Foundation Berlin and the European Fund for Regional Development. Dr. Hennerici and Dr. Brown were not involved in the study. Dr. Ebinger had no conflicts of interest. Dr. Audebert has received honoraria from Bayer, Bristol-Myers Squibb, and other companies.