Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start
The objective of this study is to quantify the increase in brain-under-protection time that may be achieved with pre-hospital compared with the post-arrival start of neuroprotective therapy among patients undergoing endovascular thrombectomy. In order to do this, a comparative analysis was performed...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.990339/full |
| _version_ | 1828147878290259968 |
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| author | Vartan Matossian Sidney Starkman Nerses Sanossian Samuel Stratton Marc Eckstein Robin Conwit David S. Liebeskind Latisha Sharma May-Kim Tenser Jeffrey L. Saver |
| author_facet | Vartan Matossian Sidney Starkman Nerses Sanossian Samuel Stratton Marc Eckstein Robin Conwit David S. Liebeskind Latisha Sharma May-Kim Tenser Jeffrey L. Saver |
| author_sort | Vartan Matossian |
| collection | DOAJ |
| description | The objective of this study is to quantify the increase in brain-under-protection time that may be achieved with pre-hospital compared with the post-arrival start of neuroprotective therapy among patients undergoing endovascular thrombectomy. In order to do this, a comparative analysis was performed of two randomized trials of neuroprotective agents: (1) pre-hospital strategy: Field administration of stroke therapy-magnesium (FAST–MAG) Trial; (2) in-hospital strategy: Efficacy and safety of nerinetide for the treatment of acute ischemic stroke (ESCAPE-NA1) Trial. In the FAST-MAG trial, among 1,041 acute ischemic stroke patients, 44 were treated with endovascular reperfusion therapy (ERT), including 32 treated with both intravenous thrombolysis and ERT and 12 treated with ERT alone. In the ESCAPE-NA1 trial, among 1,105 acute ischemic stroke patients, 659 were treated with both intravenous thrombolysis and ERT, and 446 were treated with ERT alone. The start of the neuroprotective agent was sooner after onset with pre-hospital vs. in-hospital start: 45 m (IQR 38–56) vs. 122 m. The neuroprotective agent in FAST–MAG was started 8 min prior to ED arrival compared with 64 min after arrival in ESCAPE–NA1. Projecting modern endovascular workflows to FAST–MAG, the total time of “brain under protection” (neuroprotective agent start to reperfusion) was greater with pre-hospital than in-hospital start: 94 m (IQR 90–98) vs. 22 m. Initiating a neuroprotective agent in the pre-hospital setting enables a faster treatment start, yielding 72 min additional brain protection time for patients with acute ischemic stroke. These findings provide support for the increased performance of ambulance-based, pre-hospital treatment trials in the development of neuroprotective stroke therapies. |
| first_indexed | 2024-04-11T21:06:47Z |
| format | Article |
| id | doaj.art-3e2db23ffa4649bbadfc79896afe285b |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-11T21:06:47Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-3e2db23ffa4649bbadfc79896afe285b2022-12-22T04:03:14ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-09-011310.3389/fneur.2022.990339990339Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent startVartan Matossian0Sidney Starkman1Nerses Sanossian2Samuel Stratton3Marc Eckstein4Robin Conwit5David S. Liebeskind6Latisha Sharma7May-Kim Tenser8Jeffrey L. Saver9MSTAR Program, Department of Geriatrics, University of California, Los Angeles, Los Angeles, CA, United StatesStroke Center and Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA, United StatesDepartment of Neurology, University of Southern California, Los Angeles, CA, United StatesDepartment of Emergency Medicine, University Harbor-UCLA Medical Center, Los Angeles, CA, United StatesDepartment of Emergency Medicine, University of Southern California, Los Angeles, CA, United StatesDivision of Extramural Research, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Bethesda, MD, United StatesStroke Center and Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United StatesStroke Center and Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United StatesDepartment of Neurology, University of Southern California, Los Angeles, CA, United StatesStroke Center and Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United StatesThe objective of this study is to quantify the increase in brain-under-protection time that may be achieved with pre-hospital compared with the post-arrival start of neuroprotective therapy among patients undergoing endovascular thrombectomy. In order to do this, a comparative analysis was performed of two randomized trials of neuroprotective agents: (1) pre-hospital strategy: Field administration of stroke therapy-magnesium (FAST–MAG) Trial; (2) in-hospital strategy: Efficacy and safety of nerinetide for the treatment of acute ischemic stroke (ESCAPE-NA1) Trial. In the FAST-MAG trial, among 1,041 acute ischemic stroke patients, 44 were treated with endovascular reperfusion therapy (ERT), including 32 treated with both intravenous thrombolysis and ERT and 12 treated with ERT alone. In the ESCAPE-NA1 trial, among 1,105 acute ischemic stroke patients, 659 were treated with both intravenous thrombolysis and ERT, and 446 were treated with ERT alone. The start of the neuroprotective agent was sooner after onset with pre-hospital vs. in-hospital start: 45 m (IQR 38–56) vs. 122 m. The neuroprotective agent in FAST–MAG was started 8 min prior to ED arrival compared with 64 min after arrival in ESCAPE–NA1. Projecting modern endovascular workflows to FAST–MAG, the total time of “brain under protection” (neuroprotective agent start to reperfusion) was greater with pre-hospital than in-hospital start: 94 m (IQR 90–98) vs. 22 m. Initiating a neuroprotective agent in the pre-hospital setting enables a faster treatment start, yielding 72 min additional brain protection time for patients with acute ischemic stroke. These findings provide support for the increased performance of ambulance-based, pre-hospital treatment trials in the development of neuroprotective stroke therapies.https://www.frontiersin.org/articles/10.3389/fneur.2022.990339/fullneuroprotectionemergency medical services (EMS)endovascular thrombectomy (EVT)ischemic strokeclinical trial |
| spellingShingle | Vartan Matossian Sidney Starkman Nerses Sanossian Samuel Stratton Marc Eckstein Robin Conwit David S. Liebeskind Latisha Sharma May-Kim Tenser Jeffrey L. Saver Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start Frontiers in Neurology neuroprotection emergency medical services (EMS) endovascular thrombectomy (EVT) ischemic stroke clinical trial |
| title | Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start |
| title_full | Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start |
| title_fullStr | Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start |
| title_full_unstemmed | Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start |
| title_short | Quantifying the amount of greater brain ischemia protection time with pre-hospital vs. in-hospital neuroprotective agent start |
| title_sort | quantifying the amount of greater brain ischemia protection time with pre hospital vs in hospital neuroprotective agent start |
| topic | neuroprotection emergency medical services (EMS) endovascular thrombectomy (EVT) ischemic stroke clinical trial |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.990339/full |
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