Summary
Paramedic Acute Stroke Treatment Assessment
Funder: NIHR
Background and study aims
A stroke is a serious condition where the blood supply to a part of the brain is cut off, usually by a blood clot blocking an artery or a bleed (haemorrhage). The majority of strokes are ischemic strokes. Ischemic strokes happen when the arteries that supply the brain with oxygen (carotid arteries) become narrowed or blocked, causing severely reduced blood flow (ischemia). As we age, a gradual build-up of a sticky substance called plaque can build-up in one or both of the carotid arteries. When there is a lot of plaque, particularly with a rough or irregular surface, blood clots can develop, depriving the brain of oxygen and leading to an acute ischemic stroke (AIS). This can lead to irreversible damage to the brain and long-term disability if not treated quickly. Thrombolysis, also known as “clot busting”, is a drug treatment that breaks down clots, helping to restore the blood supply to the brain. The quicker this treatment is given, the better the patient’s chance of recovery. Unfortunately, many patients do not receive thrombolysis quickly enough, as the decision to give it relies on specialist assessments, which take place after they have been admitted to hospital. Quicker access to important stroke treatments such as thrombolysis is needed, and paramedics may be able to play a more important role. Paramedic acute stroke treatment assessment (PASTA) is a new care pathway in which paramedics perform an enhanced role in stroke assessment. This involves taking down more information about the patient, providing a structured handover of stroke information to medical professionals and assistance with urgent tasks when they arrive at the hospital with the patient. The aim of this study is to find out whether implementing PASTA could have a beneficial effect on patients’ long-term recovery from an acute stroke.
Who can participate?
Adults who have suffered an acute stroke, and have been assessed by a study paramedic within 4 hours.
What does the study involve?
Study participants receive either the PASTA pathway or usual emergency stroke care, according to the paramedic who attends their emergency call. Before the start of the study, paramedics are randomly allocated to provide the PASTA pathway or to continue with usual emergency stroke care. Participants are also asked to undergo a telephone interview or to complete a postal questionnaire at 90 days after stroke. This records details about recovery after stroke, including any help required with day to day activities, and rehabilitation received since discharge from hospital.
What are the possible benefits and risks of participating?
The PASTA pathway may improve recovery, but this is not yet proven. There may be no benefits to individuals who take part in the study, however, it is hoped that care for future stroke patients will be improved as a result of this research. There are no notable risks of participating.
Where is the study run from?
North East England, North West England and Wales (UK)
When is the study starting and how long is it expected to run for?
November 2015 to April 2018
Contact Details
ISCRTN Number: 12418919;