Paramedics May be First Source of Treatment for Stroke Patients, UCLA Study Finds

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Newswise In the first study of its kind, a consortium led by UCLA physicians found that paramedics can start medications for patients in the first minutes after onset of a stroke. While the specific drug tested, magnesium sulfate, did not improve patient outcomes, the research has resulted in a new method to get promising treatments to stroke patients quickly.

The study found that, by working with paramedics in the field, intravenous medications can be given to stroke patients within the golden hour, the window in which patients have the best chance to survive and avoid debilitating, long-term neurological damage. That finding is a game changer, said study co-principal investigator Dr. Jeffrey Saver, director of the UCLA Stroke Center and professor of neurology at the David Geffen School of Medicine at UCLA.

The trial succeeded in its goal of devising a means to deliver promising drugs to stroke patients in the first minutes, when theres the greatest amount of brain to save. We have opened a new therapeutic window that is now being used to test other compounds and deliver clot-busting drugs to patients in the field, Saver said. Stroke is a true emergency condition. Time lost is brain lost - for every minute that goes by without restoration of blood flow, two million nerve cells are lost. If these patients dont get protective drugs until two, three or four hours later, irreversible brain damage will have already occurred.

The study appears in the Feb. 5, 2015 issue of the peer-reviewed New England Journal of Medicine.

The Phase III Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial involved collaboration between 315 ambulances, 40 emergency medical service agencies, 60 receiving hospitals, 715 emergency physicians, 210 neurologists, 26 neurosurgeons and 2,988 paramedics. The study demonstrated that half of the 1,700 patients in Los Angeles and Orange counties had the study drug administered within 45 minutes, while 74 percent were treated within the first golden hour.

This study involved an unprecedented cooperative effort of paramedics in the field and emergency physicians serving as investigators, said co-principal investigator Dr. Sidney Starkman, co-director of the UCLA Stroke Center and professor of emergency medicine and neurology at the David Geffen School of Medicine at UCLA. What they did was really quite heroic, and through this study we were able to instill permanently in everyones mind the idea that time is brain. We believe this represents a paradigm shift in the treatment of stroke and potentially numerous other neurological conditions.

Starkman reiterated that the study would not have been possible without the approval and confidence of the California and local emergency medical service agencies and the administrations of the participating hospitals.

Never before have so many emergency physicians, neurologists, neurosurgeons, nurses and such a large number of paramedics worked together in a National Institutes of Health study. Rapidly and without transport delay, we identified patients who were having a stroke with 96 percent accuracy, Starkman said. We demonstrated that paramedics not only are eager to provide the best possible patient care, but also are capable of being invaluable partners in an intense, time-dependent clinical trial.

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Paramedics May be First Source of Treatment for Stroke Patients, UCLA Study Finds