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Prehospital Use of Magnesium Sulfate as Neuroprotection in Acute Stroke
Journal article   Open access   Peer reviewed

Prehospital Use of Magnesium Sulfate as Neuroprotection in Acute Stroke

Jeffrey L. Saver, Sidney Starkman, Marc Eckstein, Samuel J. Stratton, Franklin D. Pratt, Scott Hamilton, Robin Conwit, David S. Liebeskind, Gene Sung, Ian Kramer, …
The New England journal of medicine, Vol.372(6), pp.528-536
02/05/2015
DOI: 10.1056/NEJMoa1408827
PMCID: PMC4920545
PMID: 25651247
url
https://doi.org/10.1056/NEJMoa1408827View
Published (Version of record) Open Access

Abstract

Background Magnesium sulfate is neuroprotective in preclinical models of stroke and has shown signals of potential efficacy with an acceptable safety profile when delivered early after stroke onset in humans. Delayed initiation of neuroprotective agents has hindered earlier phase 3 trials of neuroprotective agents. Methods We randomly assigned patients with suspected stroke to receive either intravenous magnesium sulfate or placebo, beginning within 2 hours after symptom onset. A loading dose was initiated by paramedics before the patient arrived at the hospital, and a 24-hour maintenance infusion was started on the patient's arrival at the hospital. The primary outcome was the degree of disability at 90 days, as measured by scores on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability). Results Among the 1700 enrolled patients (857 in the magnesium group and 843 in the placebo group), the mean (+/- SD) age was 69 +/- 13 years, 42.6% were women, and the mean pretreatment score on the Los Angeles Motor Scale of stroke severity (range, 0 to 10, with higher scores indicating greater motor deficits) was 3.7 +/- 1.3. The final diagnosis of the qualifying event was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. The median interval between the time the patient was last known to be free of stroke symptoms and the start of the study-drug infusion was 45 minutes (interquartile range, 35 to 62), and 74.3% of patients received the study-drug infusion within the first hour after symptom onset. There was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the magnesium group and those in the placebo group (P = 0.28 by the Cochran-Mantel-Haenszel test); mean scores at 90 days did not differ between the magnesium group and the placebo group (2.7 in each group, P = 1.00). No significant between-group differences were noted with respect to mortality (15.4% in the magnesium group and 15.5% in the placebo group, P = 0.95) or all serious adverse events. Conclusions Prehospital initiation of magnesium sulfate therapy was safe and allowed the start of therapy within 2 hours after the onset of stroke symptoms, but it did not improve disability outcomes at 90 days.
 General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology

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