Jump to content

Choose locationChoose Location
  • Sign in or Enroll
    • Open I want to choose my medical group or hospital
    • Clear my location
Change Location

We've expanded your view

You are now viewing all services in the Sutter Health network. You can change your location above to narrow your view to a medical group, hospital, city or zip.
Sutter Health
  • Video Visits
  • Find Doctors
  • Find Locations
  • Treatments & Services
  • Locations
  • Sign in or Enroll
    • Video Visits
    • Find Doctors
    • Find Locations
    • Treatments & Services
    • COVID-19 Resources
    • Pay a Bill
    • Symptom Checker
    • Get Care Today
    • Diseases & Conditions
    • Health & Wellness
    • Classes & Events
    • Research & Clinical Trials
    • For Patients
    • About Sutter Health
    • Giving
    • Volunteering
    • Careers
    • News
    • For Medical Professionals
    • Other Business Services
Close Search
  • Home
  • Patient Stories
  • “Stroke Center on Wheels” Increases Patients’ Odds
Content

PATIENT STORIES “Stroke Center on Wheels” Increases Patients’ Odds

Stroke Research at Sutter

Mills-Peninsula Medical Center

California Pacific Medical Center

Today, stroke professionals at Mills-Peninsula Medical Center (MPMC), including dedicated physicians, specialists, researchers and staff, regularly run a race against time to save people’s lives with their newest tool, the Mobile Stroke Unit (MSU).

Our team is helping pioneer the future of acute stroke care.
Sutter Health patient Ram Madduluri

Treating Stroke in the Field

The MSU is a specially equipped ambulance that is, in essence, a stroke center on wheels. “We are basically an extension of the emergency department, except we’re out in the field,” says Ilana Spokoyny, M.D., a Mills-Peninsula neurologist who serves as Clinical and Research Director of the MSU program. “The big difference is we’re able to get to patients sooner and treat them faster.”

The MSU program is part of a clinical trial called BEST-MSU. Mills-Peninsula is working in partnership with the City of San Mateo and local emergency services for the trial. Six academic medical centers across the country are also participating in the trial; Mills-Peninsula is the only community hospital involved.

“With the BEST-MSU clinical trial, for the first time in the U.S. we have an opportunity to examine the safety and feasibility of treating patients on MSUs through a national, multi-site study,” says Dr. Spokoyny. The study team hopes to enroll 1,000 eligible patients in the trial in the San Mateo County area and at other participating study sites in Memphis, New York, Denver, Indiana, and Los Angeles.

“With the Sutter MSU being the first and only MSU in Northern California and the only community hospital participating in the BEST-MSU trial, our team is helping pioneer the future of acute stroke care and advanced out-of-hospital approaches to triage.”

Tick Tick Tick

In treating stroke, time is everything. About 87 percent of strokes are ischemic, making it the most common type of stroke. Ischemic strokes are caused by a clot that blocks a blood vessel, preventing blood from flowing to the brain. When this happens, brain cells begin to die at a rate of about two million per minute.

The longer the brain goes without oxygen, the more damage the stroke can do. In fact, every hour a patient goes untreated, his or her brain ages 3.6 years in terms of loss of neuron function. That loss of brain function is why stroke is the fifth cause of death and leading cause of disability in the United States, leaving many patients unable to walk, talk, eat or take care of themselves.

Operational since December 2018, the MSU has a CT scanner on board which allows a neurologist to determine whether a patient is experiencing an ischemic stroke, a brain bleed (hemorrhagic stroke) or something unexpected. If it is determined that the patient is suffering an ischemic stroke, the patient may be a candidate to receive a drug called tissue plasminogen activator (tPA).

The “Golden Hour”

A lightning rod since it was first approved in the United States in 1996, tPA works by dissolving blood clots which helps to restore blood flow, potentially preventing additional brain cell loss. Studies have shown that tPA is most effective if administered within 60 minutes or less from when symptoms begin—what stroke professionals refer to as “the golden hour.”

“We know that patients who are treated within this special window tend to have significantly better outcomes and are more likely to have the blood clot break up from tPA,” says Dr. Spokoyny. “Since the MSU has been operational, we have treated ten patients in the field. Our treatment time from the 911 call to administering tPA to the patient is averaging approximately 42 minutes.”

Lucky Three Times Over

One of the patients whose life was impacted by the MSU and Sutter stroke research is San Carlos resident, Ram Madduluri. An active, 59-year-old tech worker at an internet-based TV service, Ram was at work when he began to experience a very sore throat. “So I went to my manager and told her I wasn’t feeling well, that I was going to go home,” says Ram. “Unbeknownst to me, I was struggling to talk, slurring my speech and my boss said, ‘You don’t look right.’”

Ram’s manager called 911 and an ambulance was dispatched immediately from the Foster City Fire Department. The MSU was activated moments later by the Fire Department.

On board the MSU, the stroke team quickly did a CT scan and Dr. Spokoyny determined that Ram was experiencing an ischemic stroke and was a good candidate for tPA. The medication was quickly mixed in the on-board pharmacy and administered.

As the MSU traveled back to the emergency department at MPMC, Dr. Spokoyny called the stroke neurologist and the on-call interventionalist. Her concern was that the large vessel in Ram’s brain might still have a blood clot and that he might need a procedure to remove it.

“But Ram had received tPA in about 37 minutes from the time of the 911 call, within the golden hour,” she says. “And by time we got to the hospital, scans showed that the large clot had dissolved into smaller clots and his symptoms had totally resolved.”

For safety, Ram reminained for observation in the ICU for 24 hours. “But, overall, Ram made a full recovery," says Dr. Spokoyny. “He had some underlying heart issues which needed attention, but that was not because of the stroke. From a stroke perspective, he returned to his normal, prior level of function.”

Rendezvous System Expands MSU’s Reach

At present, there is only one MSU in Northern California. Driving from MPMC in Burlingame to help patients who live in coastal communities can take precious time.

So the MSU team, in partnership with local emergency services, has established a set of rendezvous points—places that are flat, secure, have ample space for multiple ambulances and are typically not very populated. When the MSU is activated from a coastal community, the local ambulance picks up the patient and meets the MSU at one of these points.

If it is determined that the patient requires the services of the MSU, the person is transferred from the ambulance to the MSU. If not, the ambulance crew continues on to the nearest emergency department. “It’s an efficient way to make more areas on the Peninsula more accessible to stroke care,” says Dr. Spokoyny.

Related Stories

Stroke Patient Walks Again After Rehabilitation

Brad Barber went from being close to death, to alive but severely disabled, to walking with a cane thanks to the Sutter Rehabilitation Institute.

Life After a Traumatic Brain Injury

Andy has always been a positive person. Her care team credits her progress and remarkable recovery to her sunny outlook and determination.

TAVR Gets Dan Back to Splitting Wood

After having a minimally invasive valve replacement (TAVR) at CPMC, Dan Hogan was back to splitting wood on his ranch within weeks.

Patient Hits the Links Pain Free

After living with painful varicose veins for decades, Mark is now golfing all 18 holes thanks to a minimally invasive procedure.

Back to Life — and Sports — After Neurosurgery

They thought it was just a migraine, but it turns out Thomas, 13, had a brain tumor that required immediate surgery.

See all Patient Stories

Disclaimer

Each individual’s treatment and/or results may vary based upon circumstances and the healthcare provider’s medical judgment. Testimonials or statements made by any person(s) within this site are not intended to guarantee outcomes or substitute for medical advice.

The Sutter Health Network of Care
Expertise to fit your needs
Primary Care

Check-ups, screenings and sick visits for adults and children.

Specialty Care

Expertise and advanced technologies in all areas of medicine.

Emergency Care

For serious accidents, injuries and conditions that require immediate medical care.

Urgent Care

After-hours, weekend and holiday services.

Walk-In Care

Convenient walk-in care clinics for your non-urgent health needs.

About Sutter

  • About Our Network
  • Annual Report
  • Awards
  • Community Benefit
  • Contact Us
  • News
  • Giving
  • Find Care

  • Birth Centers
  • Care Centers
  • Emergency Rooms
  • Hospitals
  • Imaging
  • Labs
  • Surgery Centers
  • Urgent Care
  • Walk-In Care
  • View All >
  • Featured Services

  • Behavioral Health
  • Cancer Services
  • Family Medicine
  • Home Health and Hospice
  • Orthopedics
  • Pediatrics
  • Pregnancy
  • Primary Care
  • Women's Health
  • View All >
  • Patient Resources

  • Accepted Health Plans
  • Classes and Events
  • Estimate Costs
  • Flu Resources
  • Health and Wellness
  • Medical Records
  • Medicare
  • My Health Online
  • Pay a Bill
  • Symptom Checker
  • Our Team

  • For Employees
  • Physician Careers
  • Recruiting Events
  • Sutter Careers
  • Vendors
  • Volunteers
    • ADA Accessibility
    • Contact
    • Privacy
    • Do Not Sell My Personal Information

    • LinkedIn Opens new window
    • YouTube Opens new window
    • Facebook Opens new window
    • Twitter Opens new window
    • Glassdoor Opens new window
    • Instagram Opens new window

    Copyright © 2021 Sutter Health. All rights reserved. Sutter Health is a registered trademark of Sutter Health ®, Reg. U.S. Patent & Trademark office.

    Cookie Policy

    We use cookies to give you the best possible user experience. By continuing to use the site, you agree to the use of cookies. Privacy Policy Cookie Preferences

    Privacy Policy Cookie Preferences