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Fall 2005

UCLA Guides Paramedics to Fight Stroke

UCLA is spearheading the Field Administration of Stroke Therapy-Magnesium (FASTMAG) trial, which brings together all of the county’s adult-receiving hospitals, the emergency medical system and fire department paramedics to test whether magnesium sulfate can protect the threatened brain when administered by paramedics within the critical first two hours of stroke onset.

Stroke is the leading cause of disability among U.S. adults and the third-leading cause of death. Currently, the only Food and Drug Administration (FDA)- approved treatment for the most common type of stroke is a clot-dissolving drug, tissue plasminogen activator (t-PA). Only a small percentage of stroke patients receive t-PA, in part because it can be safely administered only after a brain imaging test, and by the time most patients arrive at the hospital and take the test, they have missed the three-hour time window for effective treatment.

Magnesium sulfate, which works by dilating brain blood vessels and preventing buildup of damaging calcium in injured nerve cells, is felt to be safe to give to patients who have both major stroke categories— blocking or bleeding—making it appropriate to administer in the ambulance en route to the hospital, according to Jeffrey Saver, M.D., director of the UCLA Stroke Center and principal investigator of FAST-MAG.

Dr. Saver and colleagues recently found that during every minute of a stroke, over 1 million nerve cells die. “In the most common type of stroke, an artery is blocked, and oxygen and nutrients are not being delivered to a region of the brain,” he explains. “These nerve cells can tolerate low blood flow for a few minutes, or at best a few hours. That’s the brief time window in which we have to intervene.”

More than 50 promising neuroprotective drugs for stroke work in models other than humans, Dr. Saver notes. “It’s become clear that we need to give drugs soon after onset of stroke, before much of the irreversible damage has occurred,” he says. “Using paramedics, the first healthcare personnel to come into contact with the patient, is a promising strategy.”

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