Early Initiated Ambulance-delivered Levetiracetam and Headposition in Hyper-acute Stroke Trial

EAST is a multicenter, ambulance-delivered, prospective, randomized controlled, open label blinded outcome assessment (PROBE) study to be conducted through a regional-cluster hospital network of investigators. A total of 2323 patients with suspected acute stroke will be recruited from approximately 50 hospitals in China. Potentially eligible patients will be recruited into the study by either of two mechanisms: (1) waver of consent to the intervention, and consent to follow-up obtained in hospital; or (ii) consent to the intervention through a brief written consent which is combined with a usual care consent form delivered in hospital for follow-up (if a waver of consent is not approved by the ethics committee). All patients will enter Part A and Part B at the same time, randomised allocation of intervention will be done in a 1:1 ratio in each part, using a central, automated, mobile phone Wechat mini program-based electronic randomization software according to minimization method stratified by ambulance systems, age (≥65 vs \<65) and FAST(\>2 vs =2). The intervention of Part A is to commence IV levetiracetam(LEV) 500mg as a single bolus in the ambulance and then to continue as LEV 500mg Bid orally after hospital admission for 14 days(at least 7 days if discharged or death early), compared to avoid prophylactic use of antiseizure drugs. Part B is to lie flat or sit up in the ambulance as soon as possible until hospital arrival. Ambulance staff will be well trained across the whole study to master mobile randomisation and simple key data collection. All information in ambulance, including basic demographics, randomised allocation, BP measurement and treatment details, will be collected through mobile phone based electronic database system connected with investigator clinicians in hospitals. Other relevant documents such as consent paper, BP chart will be handed over to hospital investigators. Endpoint assessment will be blinded to treatment allocation.

• neurological severity on the National Institute of Health stroke scale (NIHSS) [Срок оценки: 24 hours from randomization]
• neurological severity on the National Institute of Health stroke scale (NIHSS) [Срок оценки: 7 days]
• health related quality of life on the EQ-5D-5L [Срок оценки: 90 days]
• severe disability (mRS 3-5) [Срок оценки: 90 days]
• death and/or severe disability (mRS 3-6) [Срок оценки: 90 days]
• utility-weighted-mRS (UW-mRS) [Срок оценки: 90 days]
• proportion of hospital discharge at Day 7 [Срок оценки: 7 days]
• living circumstances questions [Срок оценки: 90 days]
• any seizures during follow-up [Срок оценки: 90 days, 6 months, 12 months]
• haematoma volume [Срок оценки: at hospital admission and 24 hours]
• Hematoma expansion [Срок оценки: 24 hours]