First-line stroke treatment may be given by paramedics

It is possible to get treatments to stroke patients even before they arrive at a hospital, according to a study published in the New England Journal of Medicine.

The study, funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, was designed to test the benefits of early administration of magnesium sulfate. It suggested that paramedics may be able to start therapy as soon as stroke is suspected.

Although the drug did not improve outcome in stroke patients, the study demonstrated the feasibility of early therapy in the ambulance.

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Lead study author Jeffrey Saver, MD, director of the University of California, Los Angeles (UCLA) Comprehensive Stroke Center, and his colleagues wanted to know if it was possible to shorten the time between stroke onset and treatment by having paramedics administer stroke therapies as soon as stroke is suspected. In most stroke trials, patients tend to receive initial treatment after undergoing tests at a hospital, which may be hours after the stroke began.

The Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial was a multicenter, randomized, placebo-controlled clinical study. In this study, 1,700 patients who were suspected of having had a stroke were given magnesium sulfate or a placebo by paramedics within 2 hours of stroke onset.

Paramedics used a version of the Los Angeles Prehospital Stroke Screen developed by the Investigators to rapidly and accurately identify potential stroke patients. Paramedics then contacted a neurologist via cellphone to further determine if a patient should be included in the study. After this contact, the patients or their representatives provided permission to the study doctor to participate in the trial.

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This study indicated that patients were able to receive a study drug faster than in other stroke trials. Analysis revealed that 74.3% of patients received a study intervention within 60 minutes of stroke onset.

“It is feasible for paramedics to accurately identify acute stroke and enroll patients into an ultra-early treatment trial,” said Walter Koroshetz, M.D., acting director of NINDS.

“The study raises the question of whether ambulance-based treatment of acute ischemic stroke with an approved drug, tPA, would improve patient outcome, reduce hospital stay and need for rehab,” Dr Koroshetz said. “Studies are now ongoing with ambulances fitted with a portable CT scanner in Cleveland [Ohio] and Houston [Texas].”