Prehospital neuroprotective therapy for acute stroke: results of the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) pilot trial.
OBJECTIVE
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.
Saver
Jeffrey L
JL
UCLA Stroke Center, Geffen School of Medicine of the University of California, Los Angeles 90095, USA. jsaver@ucla.edu
Kidwell
Chelsea
C
Eckstein
Marc
M
Starkman
Sidney
S
D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D008278:Magnesium Sulfate