Paramedic Acute Stroke Treatment Assessment (PASTA): study protocol for a randomised controlled trial

Area of Science:

• Emergency medicine
• Neurology
• Health services research

Background:

• Intravenous (IV) thrombolysis is a cost-effective treatment for acute ischemic stroke, but its delivery varies significantly across stroke services.
• This study investigates the Paramedic Acute Stroke Treatment Assessment (PASTA) pathway to address disparities in IV thrombolysis rates.

Purpose of the Study:

• To evaluate if an enhanced paramedic care pathway (PASTA) can increase the proportion of acute ischemic stroke patients receiving IV thrombolysis.
• To assess the effectiveness of pre-hospital interventions in improving timely stroke treatment.

Main Methods:

• A cluster-randomised trial involving NHS ambulance services, emergency departments, and hyper-acute stroke units in England and Wales.
• Paramedics in intervention areas used the PASTA pathway, including structured pre-hospital assessment and notification, while control areas followed standard care.
• The primary outcome was the proportion of adult stroke patients receiving IV thrombolysis within 4 hours of symptom onset.

Main Results:

• The trial enrolled 1297 participants to detect a 10% difference in IV thrombolysis rates with 90% power.
• Data analysis will determine the impact of the PASTA pathway on thrombolysis delivery.

Conclusions:

• The findings will clarify whether the PASTA pathway enhances thrombolysis rates for acute ischemic stroke.
• This research could inform future strategies for improving pre-hospital stroke care and treatment accessibility.