Heinrich Audebert, MD, Charité, Center for Stroke Research Berlin, Berlin, Germany, provides an update on the B_PROUD trial (NCT02869386) investigating the dispatch of mobile stroke units (MSUs) for patients with spontaneous acute intracerebral hemorrhage (ICH). Previously reported results from the B_PROUD study showed that patients with acute ischemic stroke benefited significantly from the dispatch of MSUs in addition to conventional ambulances. MSUs, unlike conventional ambulances, are equipped to conduct diagnostic computed tomographic (CT) scans. It was hoped that pre-hospital CT would enable earlier diagnosis of hemorrhagic strokes, allowing for intervention with blood pressure lowering agents and thus, improved outcomes. Although a decrease in pre-hospital blood pressure was observed in the group that received attention from MSUs compared to conventional ambulances alone, the effect did not translate to improved outcomes for patients with ICH. Prof. Audebert also reports that the use of early aggressive antihypertensive drugs may be harmful to those with very high blood pressure (systolic pressure of 180 mmHg). This finding, consistent with other studies, needs to be further investigated. This interview took place at the European Stroke Organisation Conference (ESOC), 2021.
Transcript (edited for clarity)
B_PROUD is actually a study in the prehospital setting of stroke where we compare patients for whom a mobile stroke unit, so an ambulance with a CT scanner on board and a neurologist on board, was dispatched and compared to a normal ambulance dispatch. The B_PROUD study showed that there was a significant and very obvious benefit for patients with ischemic stroke, but this time actually we will present the data for hemorrhagic strokes...
B_PROUD is actually a study in the prehospital setting of stroke where we compare patients for whom a mobile stroke unit, so an ambulance with a CT scanner on board and a neurologist on board, was dispatched and compared to a normal ambulance dispatch. The B_PROUD study showed that there was a significant and very obvious benefit for patients with ischemic stroke, but this time actually we will present the data for hemorrhagic strokes. There are no evidence-based treatments for hemorrhagic strokes at the moment, but our hope was that with earlier diagnosis of hemorrhagic stroke, so with the CT on the mobile stroke unit, we would be able to treat patients earlier with blood pressure lowering and also with reversal of oral anticoagulation.
What we see is actually that we were actually quite effective in lowering blood pressure, so the blood pressure at hospital arrivals were much lower in the group of mobile stroke unit care. But again, this system did not translate in around 200 patients who were included in this study into better outcome. It was more or less neutral effect, and when we look at patients who have a very high blood pressure, so higher than 180 systolic blood pressure at ambulance arrival, it even looks that early aggressive blood pressure lowering might be harmful for the patients.
So this is an interesting finding, actually it is a little bit in line with other studies like the RIGHT-2 study also with blood pressure lowering. I think this needs to be further evaluated in other studies, in other MSU studies, because normal interventional studies in stroke only include patients after hospital arrival. So this is really interesting that in the prehospital setting, it might be actually dangerous for the patient to get aggressive blood pressure lowering.
Prof. Audebert reports the following disclosures:
I am the Principle Investigator of the INSPIRE-TMS and the B_PROUD studies, as well as the ULTRAFAST prehospital stroke diagnostics project. I have been member of the Flying Interventionalist Team study steering committee.
I have received honoraria for speaker and consultancy activities from Novo-Nordisk, Pfizer, MBS, Boehringer Ingelheim, Bayer Healthcare, and Medpoint. I have received institutional funding for the different areas of my research from the German Federal Ministry for Education and Research, the Deutsche Forschung Gemeinschaft, the German Innovation-Funds and the Stiftung Deutsche Schlaganfall-Hilfe.