ABSTRACT NUMBER: ESOC2026OT165 RCT OF METOCLOPRAMIDE FOR THE PREVENTION OF PNEUMONIA IN PATIENTS WITH SEVERE STROKE: THE MAPS-2 TRIAL

Abstract Background and aims Pneumonia causes more deaths than neurological damage after stroke. Stroke-associated pneumonia is caused by aspiration of vomited/regurgitated gastric content Methods We assess whether metoclopramide, an antiemetic, prevents pneumonia, reduces mortality, and improves long-term recovery. Results This is a single-blind randomised control trial. 2100 adults within 24 hours of stroke onset, moderate to severe neurological impairment (NIHSS≥10) or dysphagia and NIHSS≥6, without pneumonia at screening, contraindications to metoclopramide, pregnancy, and life-limiting comorbidities are being recruited from over 70 UK hospitals. Patients are randomised (1:1) by minimisation on age, mRS, NIHSS, type of centre and time from onset to receive 10mg of metoclopramide/placebo (normal saline 2ml) tds via injection or nasogastric tube for 14 days. Follow-up is conducted at day 14 in person and at 6-months by telephone. Conclusions The primary outcome is all-cause mortality by 6 months. Secondary outcomes include pneumonia diagnosis, number of days of antibiotic treatment, quality of life (QOL), swallow, and neurological recovery at day 14; and mRS, frailty, QOL, swallow recovery, and home time at 6-months. Conflict of interest