Professor Dominique Cadilhac has been awarded a prestigious National Heart Foundation 2018 Vanguard grant and Future Leader Fellowship, enabling her to undertake a comprehensive program of research related to improving stroke care. One major theme includes an assessment of the costs and benefits of the Australian-first Melbourne Mobile Stroke Unit (MSU).
The MSU, staffed by a multidisciplinary team including a neurologist, nurse, radiographer and two paramedics, provides a specialist ambulance service for suspected stroke directly to patients in the community. The ambulance also has the facility for immediate brain imaging with a portable CT scanner.
Launched in November 2017 and at the time was only one of 12 in the world, the MSU reduces treatment delays and improves the chances of recovery by minimising the amount of brain damage from stroke.
Professor Cadilhac said the MSU enables pre-hospital assessment, imaging and provision of time-critical treatments prior to arrival at hospital.
“Preliminary evidence indicates that patients treated by the MSU receive treatment substantially faster compared to national averages,” Professor Cadilhac said.
“Our study will validate the clinical efficacy and cost-effectiveness of this model of care, and may be used to support the expansion or replication of the MSU service to other ambulance services within Victoria or other locations.”
It is essential that patients with suspected stroke are assessed and treated as soon as possible. For every minute that is wasted making diagnosis and treatment decisions, it is estimated that 2 million neurons die.
“Clot busting drugs (delivered within 4.5 hours) or mechanical clot retrieval (within 6 hours) can restore blood flow before major brain damage has occurred,” Professor Cadilhac said.
However, delays in hospital are common and only 1 in 4 patients are treated within the benchmark of 60 minutes from arrival.
As of the end of October, 50 of the 124 patients with confirmed ischaemic stroke occurring within 4.5 hours of symptom onset have received clot-busting medications much faster than patients who are treated in hospitals within Australia.
Professor Cadilhac said the next frontier in stroke care is to bring rapid treatment directly to the patient, and this includes the specially equipped and staffed MSU ambulance.
“Our group are leading efforts to address the cost-effectiveness of these programs internationally,” she said.
Professor Cadilhac is leading an international consortium working to pool economic data on MSUs, and her work in Australia will have national and international impact.