Specialist pre-hospital redirection for ischaemic stroke thrombectomy
Research type
Research Study
Full title
Specialist pre-hospital redirection for ischaemic stroke thrombectomy: a cluster randomised controlled trial with included health economic and process evaluations
IRAS ID
312053
Contact name
Christopher Price
Contact email
Sponsor organisation
The Newcastle upon Tyne Hospitals NHS Foundation Trust
ISRCTN Number
ISRCTN77453332
Duration of Study in the UK
3 years, 10 months, 31 days
Research summary
Stroke is a common medical emergency and time critical treatments reduce the chance of disability or death. Approximately 1 in 10 patients are suitable for an emergency operation to remove blood clots blocking large arteries in the brain (known as ‘thrombectomy’) which greatly improves their chances of recovery. However, this operation is only available at specialist regional hospitals and unless patients live nearby, they are first admitted to their local hospital and must be transferred for the treatment. A transfer typically delays thrombectomy by at least 90 minutes and reduces its benefit. Faster treatment might occur if patients could attend specialist regional hospitals directly but at present no accurate assessment or portable test exists to guide ambulance staff to make a confident diagnosis of stroke, or to determine that thrombectomy is needed.
In an earlier research project, a ‘specialist prehospital redirection pathway’ was developed which involves communication between ambulance practitioners and specialist hospital thrombectomy staff to decide whether the emergency operation is likely to be required, followed by direct admission to the specialist hospital if this is the case. This research project will now test the impact of this new pathway by conducting a multicentre cluster randomised controlled trial. Ambulance stations (work bases for ambulance practitioners) or ambulance staff teams will be assigned at random to use the new pathway or to continue with current standard care when attending suspected stroke patients. Data will be collected about thrombectomy treatments and other aspects of emergency medical care received which will be compared between the two randomisation groups.
The study will run for 3 years across 4 ambulance services which serve 6 specialist regional hospitals and involve approximately 80,000 patients with suspected or confirmed stroke. Funding is from the National Institute for Health Research.
REC name
North East - Newcastle & North Tyneside 1 Research Ethics Committee
REC reference
22/NE/0103
Date of REC Opinion
26 Jun 2022
REC opinion
Favourable Opinion