Study Demonstrates Benefit of 0° Head-of-Bed Positioning Before Thrombectomy
For patients with large vessel occlusion (LVO) stroke who are waiting for thrombectomy treatment, a 0° head position may best maintain clinical stability, whereas a 30° head position may result in a 34.4-fold higher risk for clinical worsening before receiving treatment. Results from the randomized clinical trial comparing the 2 head positions were published in JAMA Neurology.
“Delays to thrombectomy treatment can be substantial. In patients transferred between facilities, door-in/door-out times average over 2 hours nationally, and treatment delays worsen thrombectomy outcomes,” wrote Anne W. Alexandrov, PhD, University of Tennessee Health Science Center, and co-authors. “…we sought to determine whether 0° head positioning of patients with LVO who were candidates for thrombectomy was associated with greater clinical stability/improvement compared with 30°, making it an important protective maneuver before thrombectomy.”
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The prospective randomized clinical trial with blinding included 92 patients at certified thrombectomy hospitals in the United States. Those included were consecutive consenting individuals with computed tomography (CT) angiography-positive anterior or posterior LVO who were candidates for thrombectomy and had viable penumbra within 24 hours of stroke onset.
Patients were randomized to 0° or 30° head positioning and monitored every 10 minutes using the National Institute of Health Stroke Scale (NIHSS) until transferred to the catheterization table. The primary outcome was worsening of 2 or more points on the NIHSS before thrombectomy. Safety outcomes included significant neurologic exteriorization (a worsening of 4 or more points on the NIHSS), hospital-acquired pneumonia, and all-cause death within 3 months.
Of the 92 patients, 45 were randomized to 0° head positioning and 47 to 30° head positioning. Patients in the 30° group showed worsening of 2 or more NIHSS points while patients in the 0° group maintained stability in score (hazard ratio [HR], 34.40; 95% CI, 4.65-254.37; P < .001). One patient in the 0° group and 20 patients in the 30° group demonstrated worsening on the NIHSS scale of 4 points or more (HR, 23.57; 95% CI, 3.16-175.99; P = .002). No patients developed hospital-acquired pneumonia. All-cause death occurred in 2 patients from the 0° group and 10 patients in the 30° group.
“Results suggest that 0° head positioning for patients with acute LVO was a protective maneuver to maintain clinical stability in the pre-thrombectomy phase while awaiting definitive treatment,” study authors concluded.
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