Beyond the Golden Hour: Treating Acute Stroke in the Platinum 30 Minutes. Issue 8 (12th May 2022)
- Record Type:
- Journal Article
- Title:
- Beyond the Golden Hour: Treating Acute Stroke in the Platinum 30 Minutes. Issue 8 (12th May 2022)
- Main Title:
- Beyond the Golden Hour: Treating Acute Stroke in the Platinum 30 Minutes
- Authors:
- Randhawa, Anantbir S.
Pariona-Vargas, Fatima
Starkman, Sidney
Sanossian, Nerses
Liebeskind, David S.
Avila, Gilda
Stratton, Samuel
Gornbein, Jeffrey
Sharma, Latisha
Restrepo-Jimenez, Lucas
Valdes-Sueiras, Miguel
Kim-Tenser, May
Villablanca, Pablo
Conwit, Robin
Hamilton, Scott
Saver, Jeffrey L. - Abstract:
- Abstract : Background: To emphasize treatment speed for time-sensitive conditions, emergency medicine has developed not only the concept of the golden hour, but also the platinum half-hour. Patients with acute stroke treated within the first half-hour of onset have not been previously characterized. Methods: In this cohort study, we analyzed patients enrolled in the FAST-MAG (Field Administration of Stroke Therapy–Magnesium) trial, testing paramedic prehospital start of neuroprotective agent ≤2 hours of onset. The features of all acute cerebral ischemia, and intracranial hemorrhage patients with treatment starting at ≤30 m of last known well were compared with later-treated patients. Results: Among 1680 patients, 203 (12.1%) received study agents within 30 minutes of last known well. Among platinum half-hour patients, median onset-to-treatment time was 28 minutes (interquartile range, 25–30), and final diagnoses were acute cerebral ischemia in 71.8% (ischemic stroke, 61.5%, TIA 10.3%); intracranial hemorrhage in 26.1%; and mimic in 2.5%. Clinical features among platinum half-hour patients were largely similar to later-treated patients and included age 69 (interquartile range, 57–79), 44.8% women, prehospital Los Angeles Motor Scale median 4 (3–5), and early-postarrival National Institutes of Health Stroke Scale deficit 8 (interquartile range, 3–18). Platinum half-hour acute cerebral ischemia patients did have more severe prehospital motor deficits and younger age; platinumAbstract : Background: To emphasize treatment speed for time-sensitive conditions, emergency medicine has developed not only the concept of the golden hour, but also the platinum half-hour. Patients with acute stroke treated within the first half-hour of onset have not been previously characterized. Methods: In this cohort study, we analyzed patients enrolled in the FAST-MAG (Field Administration of Stroke Therapy–Magnesium) trial, testing paramedic prehospital start of neuroprotective agent ≤2 hours of onset. The features of all acute cerebral ischemia, and intracranial hemorrhage patients with treatment starting at ≤30 m of last known well were compared with later-treated patients. Results: Among 1680 patients, 203 (12.1%) received study agents within 30 minutes of last known well. Among platinum half-hour patients, median onset-to-treatment time was 28 minutes (interquartile range, 25–30), and final diagnoses were acute cerebral ischemia in 71.8% (ischemic stroke, 61.5%, TIA 10.3%); intracranial hemorrhage in 26.1%; and mimic in 2.5%. Clinical features among platinum half-hour patients were largely similar to later-treated patients and included age 69 (interquartile range, 57–79), 44.8% women, prehospital Los Angeles Motor Scale median 4 (3–5), and early-postarrival National Institutes of Health Stroke Scale deficit 8 (interquartile range, 3–18). Platinum half-hour acute cerebral ischemia patients did have more severe prehospital motor deficits and younger age; platinum half-hour intracranial hemorrhage patients had more severe motor deficits, were more often female, and less often of Hispanic ethnicity. Outcomes at 3 m in platinum half-hour patients were comparable to later-treated patients and included freedom-from-disability (modified Rankin Scale score, 0–1) in 35.5%, functional independence (modified Rankin Scale score, 0–2) in 53.2%, and mortality in 17.7%. Conclusions: Prehospital initiation permits treatment start within the platinum half-hour after last known well in a substantial proportion of acute ischemic and hemorrhagic stroke patients, accounting for more than 1 in 10 enrolled in a multicenter trial. Hyperacute platinum half-hour patients were largely similar to later-treated patients and are an attainable target for treatment in prehospital stroke trials. … (more)
- Is Part Of:
- Stroke. Volume 53:Issue 8(2022)
- Journal:
- Stroke
- Issue:
- Volume 53:Issue 8(2022)
- Issue Display:
- Volume 53, Issue 8 (2022)
- Year:
- 2022
- Volume:
- 53
- Issue:
- 8
- Issue Sort Value:
- 2022-0053-0008-0000
- Page Start:
- 2426
- Page End:
- 2434
- Publication Date:
- 2022-05-12
- Subjects:
- blood pressure -- cerebral hemorrhage -- reperfusion -- thrombectomy -- transient ischemic attack
Cerebrovascular disease -- Periodicals
Cerebral circulation -- Periodicals
616.81 - Journal URLs:
- http://ovidsp.tx.ovid.com/sp-3.16.0b/ovidweb.cgi?&S=GJCMFPNHCPDDNANKNCKKCFFBNGMHAA00&Browse=Toc+Children%7cYES%7cS.sh.15204_1441956414_76.15204_1441956414_88.15204_1441956414_96%7c411%7c50 ↗
http://www.stroke.ahajournals.org/ ↗
http://stroke.ahajournals.org/ ↗
http://journals.lww.com ↗
http://www.lww.com/Product/0039-2499 ↗ - DOI:
- 10.1161/STROKEAHA.121.036993 ↗
- Languages:
- English
- ISSNs:
- 0039-2499
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - 8474.900000
British Library DSC - BLDSS-3PM
British Library HMNTS - ELD Digital store - Ingest File:
- 23567.xml