This was a randomized controlled trial looking at the administration of magnesium to patients with suspected stroke in the prehospital environment. Magnesium had to be administered within 2 hours of symptom onset. Patients were given a 4g loading dose, followed by a 16g infusion over 24 hours. Enrolled patients were treated with usual care for a stroke including thrombolysis and thrombectomy if clinically indicated. The primary outcome was the degree of disability as assessed with the use of the modified Rankin score 3 months after the stroke.
There were 1700 patients enrolled in the study. The final diagnosis of cerebral ischaemia was made in 73.3% and ICH in 22.8%. A stroke mimic was diagnosed in 3.9% of patients. The median time for administration was 45 minutes after onset of symptoms.
There was no significant change in the 90 day disability rate with administration of magnesium. There were no significant adverse events and the study also showed that it was feasible to administer magnesium safely in the prehospital setting in a timely fashion.
This was a well designed study with an overall negative result. It did show that administration of medications for stroke can be done effectively in the field opening the door for other promising neuroprotective agents being administered in the prehospital setting.
- Saver JL et al. Prehospital use of magnesium sulphate as neuroprotection in acute stroke. NEJM 2015;372(6);528-536