Abstract T MP52: Treatment Times are Reduced by Prehospital Initiation of Neuroprotective Stroke Therapy
Background: In a typical stroke, every minute the brain loses 1.9 million neurons. An increasing focus of stroke treatment is early initiation. Paramedic initiation of stroke therapy can improve the time from symptom onset to treatment in patients suffering an acute stroke. We sought to characterize the time of prehospital therapy initiation relative to symptom onset, paramedic on-scene arrival and emergency department arrival.
Methods: All subjects were enrolled in the Field Administration of Stroke Therapy- Magnesium (FAST-MAG) clinical trial, a phase 3 trial of prehospital treatment with magnesium or placebo for patients with a symptom onset less than two hours. Subjects were assessed in the field by paramedics and provided consent via cellular contact with study investigator-physician prior to treatment.
Results: The 1700 patients enrolled in the FAST-MAG clinical trial, had a mean age of 69 [SD 14] years, 57% were male, 23% were of Hispanic ethnicity, 78% White race, 78% had pre- existing hypertension, 22% with diabetes, and 49% with hyperlipidemia. They called 911 a median [IQR] of 16 [8-36] minutes, and were assessed by on-scene paramedics 24 [15-43] minutes after symptom onset. Paramedics initiated treatment 23 [18-28] minutes after they were on-scene and 10 [5-14] minutes prior to ED arrival. Initial imaging was obtained 28 [19-40] minutes after arrival to the ED. The treatment initiation was 43 [33-58] minutes after symptom onset.
Conclusion: Pre- hospital initiation of the stroke therapy achieved a time to treatment within 60 minutes in over 75% of cases and led to the earliest recorded treatment trials in a stroke study. The strategy of prehospital initiation is an effective means in reducing time from symptom onset to treatment.
Author Disclosures: R. Sanoff: None. S.B. Cherin: None. N. Sanossian: None. R. Conwit: None. S. Hamilton: None. M. Eckstein: None. S. Stratton: None. F. Pratt: None. D. Liebeskind: None. L. Ali: None. M. Kim- Tenser: None. L. Restrepo: None. M. Valdes- Sueiras: None. S. Starkman: None. J.L. Saver: None.
- © 2014 by American Heart Association, Inc.