Prehospital Stroke Treatment Trials in Conventional EMS Settings: An Expert Consensus Statement on Operational, Ethical, and Technological Priorities
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.
Authors
- Craig S. Anderson (ORCID: https://orcid.org/0000-0002-7248-4863)
- Andrew M. Demchuk (ORCID: https://orcid.org/0000-0002-4930-7789)
- Aravind Ganesh (ORCID: https://orcid.org/0000-0001-5520-2070)
- Philip M. Bath (ORCID: https://orcid.org/0000-0003-2734-5132)
- Mayank Goyal (ORCID: https://orcid.org/0000-0001-9060-2109)
- Alexander Stebner (ORCID: https://orcid.org/0009-0003-8895-0894)
- Bob Roozenbeek (ORCID: https://orcid.org/0000-0002-8320-8303)
- Cheryl E. Carcel (ORCID: https://orcid.org/0000-0001-8942-953X)
- Michael D. Hill (ORCID: https://orcid.org/0000-0002-6269-1543)
- Salome Lou Bosshart (ORCID: https://orcid.org/0009-0007-7570-8723)
- H. Bart van der Worp (ORCID: https://orcid.org/0000-0001-9891-2136)
- Jonathan Coutinho
- Jeffrey Saver
- Nishita Singh
Institutions
- University of Nottingham (GB)
- University of California, Los Angeles (US)
- University of Calgary (CA)
- Utrecht University (NL)
- Royal Prince Alfred Hospital (AU)
- Erasmus MC (NL)
- University Hospital of Basel (CH)
- University of California System (US)
- University Medical Center Utrecht (NL)
- UNSW Sydney (AU)
- Prince of Wales Hospital (AU)
- The George Institute for Global Health (AU)
- Kantonsspital Münsterlingen (CH)
- Amsterdam University Medical Centers (NL)
- Shanghai Center for Brain Science and Brain-Inspired Technology (CN)
- University of Manitoba (CA)
Publication Details
- Journal
- Stroke
- Published
- 2026-09-28
- DOI
- https://doi.org/10.1161/strokeaha.126.056028
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00