Prehospital Stroke Treatment Trials in Conventional EMS Settings: An Expert Consensus Statement on Operational, Ethical, and Technological Priorities
Abstract
Prehospital stroke trials enable assessments of ultraearly administration of treatments and management strategies, but face unique challenges in their design, conduct, and analysis. We outline important considerations and recommendations for planning prehospital stroke trials, focusing on patient identification, consent models, randomization strategies, end point selection, and statistical frameworks. As this field evolves, multidisciplinary collaboration, pragmatic study design, and scalable technology integration are critical to ensuring scientific rigor and equitable access. This framework is intended to inform and support future investigators in designing effective, ethically sound, and operationally feasible prehospital stroke trials in conventional emergency medical services settings.
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Authors: Nishita Singh, Jeffrey Saver, Aravind Ganesh, Jonathan Coutinho, Bob Roozenbeek, Salome Lou Bosshart, Alexander Stebner, Andrew M. Demchuk, Michael D. Hill, Philip M. Bath, Cheryl E. Carcel, Craig S. Anderson, Mayank Goyal, H. Bart van der Worp
Institutions: University of California, Los Angeles, The George Institute for Global Health, University Hospital of Basel, Amsterdam University Medical Centers, University of Nottingham, University of Calgary, UNSW Sydney, Erasmus MC, University of Manitoba, Utrecht University, University of California System, University Medical Center Utrecht, Royal Prince Alfred Hospital, Shanghai Center for Brain Science and Brain-Inspired Technology, Prince of Wales Hospital, Kantonsspital Münsterlingen