Abstract 87: Prehospital Treatment with Magnesium Does not Prevent Ultra-Early Clinical Deterioration in Stroke
Background: We had previously reported that deterioration of the clinical examination between paramedic evaluation and Emergency Department (ED) evaluation was associated with worse outcome in hyperacute stroke patients. Prehospital treatment with magnesium (Mg), a neuroprotective agent, may reduce rates of ultra-early clinical deterioration (UECD).
Methods: All subjects from the NIH Field Administration of Stroke Therapy- Magnesium phase 3 clinical trial were randomized to intravenous Mg (4gm field loading dose followed by 16gm over 24 hours) or placebo and evaluated in the field by paramedics and in the ED by study nurses. UECL was defines as a worsening in the GCS by >=1 point. Outcome was assessed at 3 months using the modified Rankin score (mRS)
Results: Among the 1700 enrolled patients (857 magnesium group, 843 placebo group), mean age was 69 (SD±13), 42.6% were female, final diagnosis of the presenting event was cerebral ischemia (CI) in 73.3%, intracranial hemorrhage (ICH) in 22.8%, and mimic in 3.9%. Median time from last known well to initial paramedic evaluation was 23 minutes (IQR 14-42) and to ED nurse evaluation was 150 minutes (120-180). UECD was noted in 311 (18%). Treatment with Magnesium did not affect rates of UECD in the overall population (19% vs. 17% p=0.307), those with CI (13% vs. 12%, p=0.318) and those with ICH (40% vs. 37%, p=0.557). Patients with UECD had very low rates of good outcome (mRS 0-2) overall (18% vs. 60%, p<0.001), in CI (23% vs. 63%, p<0.001) and ICH (11% vs 41%, p<0.001).
Conclusions: Rates of ultra-early clinical deterioration were high, particularly among ICH patients presenting <2 hours from symptom onset. Treatment with magnesium had no effect on ultra-early clinical deterioration, which was associated with poor outcome. Future studies of prehospital therapy in stroke may consider using UECD as an outcome measure.
Author Disclosures: N. Sanossian: Consultant/Advisory Board; Modest; Covidien. D.S. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. S. Strakman: None. M. Eckstein: None. S. Stratton: None. F.D. Pratt: None. S. Hamilton: None. R. Conwit: None. J.L. Saver: None.
- © 2015 by American Heart Association, Inc.