PREhospital Routage of Acute STroke Patients With Suspected Large Vessel Occlusion: Mothership Versus Drip and Ship

NCT ID: NCT04121013

Last Updated: 2021-04-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-30

Study Completion Date

2022-01-31

Brief Summary

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Background: The outcome of ischemic stroke is related to the brain lesion volume and this volume of infarction is directly related to the time to reperfusion, which therefore depends on the time to initiation of therapy. Acute ischemic stroke is treated medically with the administration of intravenous rtPA, but recent randomized controlled trials have shown the efficacy of mechanical thrombectomy and is now the new gold standard in ischemic stroke. This new therapeutic strategy has created two possibilities for pre-hospital decision-making: i/ transport the patient directly to the nearest stroke unit to receive alteplase and then if indicated perform a thrombectomy (drip and ship) or ii/ bypassing thrombolysis centres in favour of endovascular thrombectomy (mothership).

Objective: To compare cost/effectiveness of transfer to the closest local stroke centre or telemedicine hub to direct transfer to the comprehensive stroke cent(CSC) in patients acute stroke with suspected large vessel occlusion.

Medical and economic expected impact: We hypothesize that direct transportation to CSC is associated with better clinical outcome in case of acute ischaemic stroke due to intracranial large vessel occlusion. However, we have to demonstrate that this approach is not associated with time from onset harm in patients not eligible to mechanical thrombectomy.

Detailed Description

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Design: Multicenter, two-arm, prospective, open, blinded end-point (PROBE), randomized, clinical trial

Primary endpoint: Incremental cost-utility ratio at 12 months. Secondary endpoints: modified Rankin scale and EuroQoL5D scale at 3 months.

Eligibility criteria: A call to the emergency medical assistance service, 18 years and older, severe acute stroke symptoms, transportation time from scene to the CSC longer than time to go to the nearest stroke unit or telemedicine hub, transportation time from scene to the CSC compatible with IV thrombolysis, known time from onset, RACE score (assessed by medical emergency technicians) ≥5.

Experimental arm: direct transportation to the CSC. Control arm: transfer to the closest local stroke centre or telemedicine hub.

Sample size: 800 patients, 400 for each arm.

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Mothership

Acute stroke patients with suspected large vessel occlusion will be directly transferred to the nearest transportation to the endovascular center

Group Type ACTIVE_COMPARATOR

mothership

Intervention Type OTHER

Randomized controlled study: allocation to active or no intervention arm will be done accordingly to the design temporal sequence

drip'n'ship

Acute stroke patients with suspected large vessel occlusion will be transferred to the closest local stroke centre or telemedicine hub as done with the current stroke protocol

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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mothership

Randomized controlled study: allocation to active or no intervention arm will be done accordingly to the design temporal sequence

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* A call to the emergency medical assistance service;
* age\> 18y,
* known time of stroke onset;
* transportation time from scene to the CSC longer than time to go to the nearest stroke unit or telemedicine hub;
* transportation time from scene to the CSC compatible with IV thrombolysis;
* known time from onset, RACE score ≥5.

Exclusion Criteria

* transportation time from scene to the CSC longer than time to go to the nearest stroke unit or telemedicine hub.
* no ambulance available
* bedridden patient
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Caen

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Emmanuel Touze, Pr

Role: PRINCIPAL_INVESTIGATOR

University hospital of Caen

Locations

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University hospital of Caen

Caen, Normanide, France

Site Status RECRUITING

Countries

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France

Central Contacts

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Richard Macrez, Dr

Role: CONTACT

0231470213

emmanuel touze, Pr

Role: CONTACT

Facility Contacts

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Richard Macrez, Dr

Role: primary

0231470213

Emmanuel Touze, Pr

Role: backup

Other Identifiers

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2018-A02873-52

Identifier Type: -

Identifier Source: org_study_id

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