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Melbourne – the Frontier of Stroke Research

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Stroke is one of Australia’s biggest killers. With 56,000 new and recurrent strokes every year, it’s a race against the clock to treat patients before they lose valuable brain tissue. But with an innovative new approach being tested by Australian researchers and clinicians, the stage is set for a massive change in the way we treat stroke.

In recognition of National Stroke Week, Neuroscience Trials Australia is showcasing one of the most important clinical trials being conducted in Melbourne today, the Mobile Stroke Unit (MSU) project. The MSU, a new type of ambulance, is primed to solve a problem that has troubled researchers for over 20 years.

When treating stroke, it is well-established that time is a critical factor- one that determines patient outcomes of recovery, life-long disability or death. Ruminating on this imperative, a new idea was born: a specialised ambulance service that could deliver brain scans and potentially life-saving drugs to stroke patients before they arrive at the hospital.

The MSU trial is a multi-faceted and complex scientific study. The ambulance is equipped with commonly used stroke drugs, such as the thrombolytic (‘clot-busting’) tPA, a CT scanner and specialist neurology medical and nursing staff. In addition to this, the MSU is also a testing bed for novel therapeutics and biomarkers that are being investigated across a number of trials and studies. This trial-within-a-trial structure makes this project groundbreaking, unique and powerful compared to other MSU pilots being conducted around the world.

Spearheaded by world-leading stroke clinician-researchers, Professor Stephen Davis AM and Professor Geoffrey Donnan AO, the MSU project is the result of a collaborative effort between:
• The Royal Melbourne Hospital
• Ambulance Victoria
• The University of Melbourne
• The Florey Institute of Neuroscience and Mental Health
• The Stroke Foundation
• The RMH Neuroscience Foundation and;
• The State Government of Victoria.

This trial draws upon the knowledge and experience of a multi-skilled team, ranging from specialist paramedics, stroke neurologists and nurses, to engineers and neuroimaging experts, many of whom are cross-trained. This was no more evident than during the extensive planning phase, where a mock vehicle was built and treatment procedures were rehearsed by the complex mixture of user groups, modifying and optimising the plans for the vehicle layout and the clinical workflows.

This level of preparation has proven to be invaluable. Since its inception in November last year, the MSU has attended and assessed over 327 patients. Compared to standard emergency protocols, the MSU has been a median treatment time some 53 minutes faster than the median for standard in-hospital models of stroke care. Similarly, the frequency of stroke patients treated with clot-busting drugs during the crucial ‘golden hour’ (first hour after stroke onset) has risen from 2% to 12%.

Since its establishment, the MSU has been delivering impressive results. However, those involved in the project understand the importance of demonstrating both long-term clinical and economic benefits to ascertain the viability of such a revolutionary idea.

As a part of this sizable collaboration, Neuroscience Trials Australia is proud to have a role in facilitating one of the major trials running on the MSU vehicle: the STOP-MSU trial. This trial is assessing the efficacy of intravenous tranexamic acid in reducing the rate of haematoma growth in patients with intracerebral haemorrhage. Commenced in July and with four patients enrolled in the trial to date, the research team hopes to better understand the effect this therapeutic has in improving the lives of stroke patients.

Excitingly, there are plans to expand the MSU catchment area next year, with discussions of introducing the MSU into regional areas, and strong interest from other States looking to adopt a similar hyperacute model of care. With this taken into consideration, it is forecast that there will be preliminary results from the MSU trial before the five years of its current funding ends, with the important Year 1 economic and clinical impact report due by the end of the year.

The MSU trial positions Melbourne at the frontier of stroke research. With leaders from academic, clinical and paramedic fields coming together to improve treatment protocols and health outcomes for stroke patients, we can look forward to hearing more success stories in the future.