RIGHT-2 stroke research study

EEAST Lozenge and crest right aligned

The first paper from RIGHT-2 has now been published, and the results are summarised below:

In 2016, EEAST joined seven other ambulance services taking part in RIGHT-2, the research study investigating whether transdermal GTN, a nitric oxide donor, might improve outcome when administered very early after stroke onset.

Adult patients were eligible to participate in RIGHT-2 if they had a presumed stroke within 4hrs of onset, FAST score of 2 or 3, and a minimum systolic blood pressure 120mmHg. Transdermal GTN treatment began at home or on route to hospital, and continued in hospital. The study primary outcome measure was the patient modified Rankin Scale (mRS; a measure of functional outcome) at 90 days following stroke onset.

In total, study paramedics recruited a total of 1149 stroke patients into RIGHT-2, 178 of which came from EEAST. This was an amazing achievement for all involved.

At final diagnosis, 52% patients had ischaemic stroke, 13% had intracerebral haemorrhage, 9% had transient ischaemic attack, and 26% had a non-stroke mimic.

For the patients that received GTN, their blood pressure was lowered by 5ยท8/2.6mmHg, compared with the control group.

Overall, there was no difference in mRS between the GTN and control participants, and there were no differences in secondary outcome measures, death or serious adverse events. However, it was noted that there was tendency for harm/worse functional outcome in patients with intracerebral bleeds, very early strokes (<1hr onset), and severe strokes.

What does this all mean?

  • UK paramedics can obtain consent and treat patients with stroke in the ultra-acute prehospital setting for high-calibre stroke research studies.
  • Pre-hospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke.
  • RIGHT-2 has highlighted that hyper-acute stroke patients in the ambulance setting appear to differ from hyper-acute stroke patients in hospital.
  • Further research is warranted for optimal blood pressure management and improved patient outcomes for hyper-acute stroke patients.

You can read more about these findings here:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30194-1/fulltext; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30276-4/fulltext

Published 12th February 2019

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