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 < or = 2) occurred in 60%. No serious adverse events were associated with field therapy initiation. 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.
BACKGROUND AND PURPOSE: To demonstrate that paramedic initiation of intravenous magnesium sulfate (Mg) in the field in focal strokepatients 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 < or = 2) occurred in 60%. No serious adverse events were associated with field therapy initiation. CONCLUSIONS: Field initiation of Mg sulfate in acute strokepatients is feasible and safe. Prehospital trial conduct substantially reduces on-scene to needle time and permits hyperacute delivery of neuroprotective therapy.
Authors: Stephen F Traynelis; Lonnie P Wollmuth; Chris J McBain; Frank S Menniti; Katie M Vance; Kevin K Ogden; Kasper B Hansen; Hongjie Yuan; Scott J Myers; Ray Dingledine Journal: Pharmacol Rev Date: 2010-09 Impact factor: 25.468
Authors: Nerses Sanossian; Sidney Starkman; Mark Eckstein; Samuel Stratton; Frank Pratt; Robin Conwit; Jeffrey L Saver Journal: Cerebrovasc Dis Date: 2010-07-28 Impact factor: 2.762
Authors: J Andrew McKee; Randall P Brewer; Gary E Macy; Cecil O Borel; James D Reynolds; David S Warner Journal: Neurocrit Care Date: 2005 Impact factor: 3.210
Authors: Duika L Burges Watson; Randy Sanoff; Joan E Mackintosh; Jeffrey L Saver; Gary A Ford; Christopher Price; Sidney Starkman; Marc Eckstein; Robin Conwit; Anna Grace; Madeleine J Murtagh Journal: Ann Emerg Med Date: 2012-03-03 Impact factor: 5.721