A first-of-its-kind study has found that it is possible for paramedics to safely give intravenous medications to stroke patients in the early minutes after symptoms start.
In the government-funded study, published Feb. 5 in the New England Journal of Medicine, researchers found that although starting a drug called magnesium sulfate in the ambulance did not reduce disability in stroke patients, the study nonetheless offered proof that it was safe and feasible to get treatment to patients faster.
Among 1,700 Los Angeles-area patients in the study, 74 percent were treated within the first hour — the critical window after stroke symptoms start when patients have the best chance to survive and avoid debilitating brain damage.
Researchers collaborated with 60 receiving hospitals and nearly 3,000 paramedics from 40 emergency medical service agencies.
Jeffrey Saver, M.D., a director at the UCLA Stroke Center and a lead investigator on the study, dubbed FAST-MAG, first presented the findings at the American Stroke Association’s 2014 International Stroke Conference.
“Time lost is brain lost. For every minute that goes by without restoration of blood flow, two million nerve cells are lost,” Saver said in a statement. “If these patients don’t get protective drugs until two, three or four hours later, irreversible brain damage will have already occurred.”
About 795,000 Americans suffer a stroke each year. Stroke is the nation’s No. 5 cause of death and a leading cause of disability.
Currently, the only U.S. Food and Drug Administration-approved drug for clot-caused strokes is the clot-dissolving medicine tissue plasminogen activator, or tPA. However, it cannot be given until the patient arrives at the hospital and a clot is confirmed by brain imaging.
Other neuroprotective drugs such as intravenous magnesium can be delivered in the field because they are safe for both clot-caused strokes and bleeding-type strokes, Saver said.
“The most important finding of this study was that medication could be delivered within the ‘golden hour,’” Saver said. “FAST-MAG has opened a new, earlier-than-ever window for treatment that has the potential to significantly improve outcomes for the hundreds of thousands of people each year who suffer a stroke.”
Clinical trials are now under way in the U.S., Canada and England testing new compounds using the early treatment infrastructure created by the FAST-MAG study, said Saver.