A photo composite of a kitchen timer set to thirty minutes over a computer rendered brain.

What golden hour for a stroke? Introducing “Platinum Half Hour”


Researchers have stepped up the “golden hour” concept in stroke, finding that ultra-early intervention after a stroke is an achievable goal.

The FAST-MAG study, originally designed to test for magnesium as a neuroprotective agent, had 12.1% of 1,680 stroke patients treated by paramedics within 30 minutes of the last time they were known to be healthy, according to Fatima Pariona- Vargas, MD, of the Peruvian Medical School of the National University of Cajamarca and colleagues.

Administration of magnesium in this “platinum half hour” did not lead to better three-month functional results. “However, once beneficial therapy can be initiated in outpatient clinics, platinum half-hour treatment is likely to be associated with the maximum benefit of the intervention,” the authors argued in their work. Stroke.

Given the precious minutes spent waiting for the EMS to arrive at the site and transport the patient, prehospital treatment is probably the only practical way to take advantage of stroke interventions during the platinum half hour, the researchers said.

The 12.1% treatment rate within 30 minutes by FAST-MAG paramedics is “very impressive,” said James Grotta, MD, a vascular neurologist at Memorial Hermann Health System and director of the Houston Mobile Stroke Unit.

“The study underscores the importance and potential value of moving treatment to the prehospital environment,” he said MedPage today.

Neuroprotective agents would theoretically account for the safe, ultra-early prehospital treatment of hemorrhagic and ischemic stroke. We hope that agents would allow routine ambulances to omit the imaging needed to distinguish between the two when administering intravenous (IV) thrombolysis and other treatments.

A good neuroprotective can give paramedics more time for other therapies once they confirm that the patient has a hemorrhagic or ischemic stroke, said Tudor Jovin, MD, a neurologist for stroke, of Cooper Medical School Rowan University in Camden, New Jersey.

Yet again and again, researchers fail to identify a good agent.

NA-1 is one neuroprotective that is still under investigation in the FRONTIER study.

Although FAST-MAG has not been shown to be effective for prehospital IV magnesium ≤ 2 hours after the onset of stroke, magnesium as a glutamate antagonist may still have neuroprotective effects if administered very early and studied in a larger sample, Grotta suggested.

Regarding rapid reperfusion therapy, he said that tenecteplase (TNKase) promises rapid administration – possibly feasible within the first 30 minutes.

“I think we are entering a new era in the treatment of acute stroke, when these types of approaches are becoming feasible,” Jovin said.

He noted that in addition to prehospital therapy, there is also a need for faster detection of stroke in the field. To this end, devices are being developed to detect stroke when it occurs. “It’s something we used to think was science fiction. It looks more and more a reality – it’s not widely used yet, but hopefully soon,” he said.

Pariona-Vargas and colleagues performed a phase III exploratory analysis of the FAST-MAG study.

The study participants had a median age of 69 years and the group included approximately 45% women. Patients achieved a median of 4 in the pre-hospital Los Angeles Motor Scale and 8 in the early hospitalization of NIH Stroke Scale deficits.

In FAST-MAG, some patients were more likely to be treated in platinum half an hour:

  • Acute cerebral ischemia: patients with severe motor deficit at the first prehospital examination and younger age
  • Intracranial cranial hemorrhage: women, non-Hispanic people and people with more severe motor deficits

Jovin highlighted the high rate of correct diagnosis of rescue vascular emergency, as only 2.5% of patients with FAST-MAG proved to have stroke mimics.

The study authors acknowledged that they lacked routine results of early vascular imaging upon hospital arrival and subsequent imaging. This prevented them from evaluating the impact of large vessel occlusion on early presentation and also left them in the dark regarding infarct growth after hematoma arrival and expansion.

“These data have paved the way for future clinical trials to test the type of prehospital treatment that will be required to reach stroke patients during this crucial platinum period,” said Anthony Kim, MD, MAS, medical director of the University of California, San Francisco. Comprehensive stroke center.

He said Meanwhile, the EMS and the Emergency Medicine Department were already using other strategies – from raising public awareness of stroke symptoms to revising prehospital classifications and routing protocols – to reduce the time it takes to treat stroke patients.

“The bottom line is that you could expect better results with earlier treatment,” Grotta said.

  • Nicole Lou is a MedPage Today reporter who specializes in cardiology and other medical developments. Follow

Disclosure

FAST-MAG was funded by an NIH grant.

The study’s co-authors revealed relationships with Cerenovus, Medtronic, BrainsGate, BrainQ, Rapid Medical, Genentech and Stryker.

Pariona-Vargas, Jovin and Kim had no relevant information.

Grotta has announced advice for companies that manufacture mobile stroke units.





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