For stroke victims, time is precious. Every second without treatment could spell further brain damage, disability or death. Thanks to some recent developments in the field, though, experts hope the paradigm in stroke care is finally starting to shift.
Just last week, a group of researchers led by the University of California, Los Angeles, announced the results of a clinical trial that aimed to administer treatment to stroke patients much more quickly. In the study, published in the New England Journal of Medicine, paramedics traveled to the scene and administered the Los Angeles Prehospital Stroke Screen, developed by the investigators. The EMTs then phoned a neurologist for further instruction.
While the drug used in the trial, magnesium sulfate, proved to be ineffective in improving stroke outcomes in the first 90 days, paramedics were able to deliver treatment far faster than other stroke trials and that's what excites the experts. Future trials will look for more effective medications. In this case, some 74.3 percent of patients received treatment within 60 minutes of the onset of symptoms — crucial since victims lose an estimated 2 million brain cells each minute after suffering a stroke. Jeffrey Saver, M.D., director of the UCLA Comprehensive Stroke Center, believes the results are promising. "These are exciting times."
"We know that time lost is brain lost in acute, ischemic stroke, and every minute that goes by, 2 million more nerve cells are lost," says Saver, who is also a professor of neurology. "It's critical to be able to access the threatened brain as early as possible after the start of stroke symptoms. This study showed that, by moving potential treatments into the ambulance, we are able to get drugs to patients much faster than ever before, and that a paramedic-based system can have the drug started within that first golden hour for three-quarters of patients."
In the January issue of Hospitals & Health Networks, we explored how pioneers in the Cleveland and Houston regions are similarly innovating in how they treat such stoppages of blood flow to the brain. There, health systems are rolling out "mobile stroke units" — ambulances fitted with a mobile computed tomography scanner, and staffed by some mixture of paramedics, neurologists, nurses and CT technicians. The method was first pioneered in Germany, where researchers demonstrated that the specialized ambulance can get treatment to patients 36 minutes quicker than average.
One obstacle to widespread adoption of mobile stroke units, experts told us, is the heavy price tag. Memorial Hermann Medical Center's unit required some $1 million in startup costs, raised by the group of institutions involved in the Houston-area experiment. Experts there, however, argued that it's worth the expense. Strokes are a particularly pressing problem, with some 800,000 cases in the United States each year, costing the country about $38 billion annually.
Back in the Los Angeles region, Saver hopes that the method its researchers used, with a standard ambulance and paramedic crew, proves to be more easily scaled, once they find an effective drug. He points to three other ongoing trials around the world using similar methods but different treatments, and UCLA is now testing FAST-BP (field administration of stroke therapy-blood pressure lowering) in a small pilot in Orange County at eight receiving hospitals.
"The need to get treatments to the threatened brain faster is driving all sorts of innovations in stroke research and care," Saver says. "What we tested uses the standard, U.S. paramedic system already in place to deliver drugs that could be given safely to both bleeding stroke patients and ischemic stroke patients. If we get a drug that works in this fashion, then it could be immediately implemented at ambulances throughout the country."
