on March 11, 2004
Published online before print March 11, 2004, doi: 10.1161/01.STR.0000124458.98123.52
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Submitted on July 31, 2003
From Stroke Center (J.L.S., C.K., S.S.), Department of Neurology (J.L.S., C.K., S.S.), and Department of Emergency Medicine (S.S.), Geffen School of Medicine of the University of California, Los Angeles; and Department of Emergency Medicine (M.E.), Keck School of Medicine of the University of Southern California and Los Angeles Fire Department. * To whom correspondence should be addressed. E-mail: jsaver{at}ucla.edu.
Background and Purpose--To demonstrate that paramedic initiation of intravenous magnesium sulfate (Mg) in the field in focal stroke patients is feasible, safe, and yields significant time-savings compared with in-hospital initiation of neuroprotective therapy. Methods--We performed an open-label clinical trial. Inclusion criteria were: (1) likely stroke as identified by the Los Angeles Prehospital Stroke Screen; (2) age 45 to 95; and (3) treatment initiation within 12 hours of symptom onset. Paramedics initiated 4 g Mg loading dose in the field, followed by 16 g over 24 hours in hospital. Results--Twenty patients were enrolled, with mean age 74 (range 44 to 92), and 50% were male. Final diagnosis was acute cerebrovascular disease in all (ischemic 80%, hemorrhagic 20%). Study agent infusion began a median of 100 minutes after symptom onset (range 24 to 703), and 70% received study agent within 2 hours of onset. The interval from paramedic arrival on scene to study agent start was: field-initiated, 26 minutes (range 15 to 64) versus in-hospital initiated (historic controls), 139 minutes (range 66 to 300; P<0.0001). Paramedics rated patient status on hospital arrival as improved 20%, worsened 5%, and unchanged 75%. Median NIHSS on hospital arrival was 11 in all patients and 16 in patients unchanged since field treatment start. Good functional outcome at 3 months (Rankin Conclusions--Field initiation of Mg sulfate in acute stroke patients is feasible and safe. Prehospital trial conduct substantially reduces on-scene to needle time and permits hyperacute delivery of neuroprotective therapy.
Revised on January 7, 2004
Accepted on January 12, 2004
Prehospital Neuroprotective Therapy for Acute Stroke: Results of the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) Pilot Trial
Jeffrey L. Saver MD*;
2) occurred in 60%. No serious adverse events were associated with field therapy initiation.
Key words: stroke • neuroprotection • emergency medical services • clinical trials
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