Trial reportEmergency medicine journal : EMJ2014
Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST): results from the pilot randomised controlled trial.
Trial report in Emergency medicine journal : EMJ, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01066572 (Paramedic Initiated Lisinopril For Acute Stroke Treatment), which is not on this map. Cited by 33 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Paramedic Initiated Lisinopril For Acute Stroke Treatment: a Pilot Randomised Controlled Trial
Who cites it
33 citing papers in PubMed, 6 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- 2025 update to European Stroke Organisation (ESO) guideline on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.European stroke journal · 2026Guideline
- A systematic review of ambulance service-based randomised controlled trials in stroke.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023Pooled it
- Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review.BMC medical research methodology · 2017Pooled it
- Effect of waivers of consent on recruitment in acute stroke trials: A systematic review.Neurology · 2016Pooled it
- Pooled it
- Interventions for deliberately altering blood pressure in acute stroke.The Cochrane database of systematic reviews · 2014Pooled it
- Challenges and Experiences in Multicenter Prehospital Stroke Research: Narrative Data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial-2 (RIGHT-2).Prehospital emergency care · 2024Trial
- Trial
- Frequency, Predictors, and Outcomes of Prehospital and Early Postarrival Neurological Deterioration in Acute Stroke: Exploratory Analysis of the FAST-MAG Randomized Clinical Trial.JAMA neurology · 2018Trial
- The intracerebral hemorrhage acutely decreasing arterial pressure trial II (ICH ADAPT II) protocol.BMC neurology · 2017Trial
- Trial
- Methodology of the Field Administration of Stroke Therapy - Magnesium (FAST-MAG) phase 3 trial: Part 1 - rationale and general methods.International journal of stroke : official journal of the International Stroke Society · 2014Trial
- Blood Pressure Management in Neurologic Emergencies.Emergency medicine clinics of North America · 2026Review
- Physiological Variability during Prehospital Stroke Care: Which Monitoring and Interventions Are Used?Healthcare (Basel, Switzerland) · 2024Review
- Blood Pressure Variability in Acute Stroke: A Narrative Review.Journal of clinical medicine · 2024Review
- Prehospital Stroke Care Part 2: On-Scene Evaluation and Management by Emergency Medical Services Practitioners.Stroke · 2023Review
- Review
- European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage.European stroke journal · 2021Article
- Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review.Brain sciences · 2021Review
- Blood Pressure Management in Acute Ischemic Stroke.Current hypertension reports · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundHigh blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited.
methodsWe conducted a pilot RCT to determine the feasibility of a definitive prehospital BP-lowering RCT in acute stroke. Paramedics were trained to identify, consent and deliver a first dose of lisinopril or placebo to adults with suspected stroke and hypertension while responding to the emergency call. Further treatment continued in hospital. Study eligibility, recruitment rate, completeness of receipt of study medication and clinical data (eg, BP) were collected to inform the design of a definitive RCT.
resultsIn 14 months, 14 participants (median age=73 years, median National Institute of Health Stroke Scale=4) were recruited and received the prehospital dose of medication. Median time from stroke onset (as assessed by paramedic) to treatment was 70 min. Four participants completed 7 days of study treatment. Of ambulance transported suspected stroke patients, 1% were both study eligible and attended by a PIL-FAST paramedic.
conclusionsIt is possible to conduct a paramedic initiated double-blind RCT of a treatment for acute stroke. However, to perform a definitive RCT in a reasonable timescale, a large number of trained paramedics across several ambulance services would be needed to recruit the number of patients likely to be required. CLINICAL
trial registrationhttp://www.clinicaltrials.gov. Unique identifier: NCT01066572.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.