Positioning stroke patients with their heads flat before thrombectomy could significantly enhance neurological function and clinical stability.
That is according to a new study presented at the American Stroke Association’s International Stroke Conference 2024.
This late-breaking science presentation could potentially revolutionise the standard of care for stroke patients awaiting thrombectomy.
The study, Zero Degree Head Positioning in Acute Large Vessel Ischemic Stroke (ZODIAC), revealed compelling evidence supporting the benefits of 0-degree head positioning.
It was conducted by researchers from the University of Tennessee Health Science Center in Memphis and presented by lead researcher Anne W Alexandrov.
Large vessel occlusion stroke, caused by a clot blocking a major artery in the brain, requires a timely thrombectomy to restore blood flow and prevent further brain damage.
Traditionally, stroke patients awaiting thrombectomy have their hospital beds positioned at a 30-degree angle.
However, preliminary findings from the trial suggest that flat head positioning before surgery could optimise blood flow and improve outcomes.
Dr Alexandrov emphasised the importance of maintaining adequate blood flow to the brain while patients await surgery, particularly given potential delays in the procedure.
Pilot studies preceding ZODIAC indicated that 0-degree head positioning could enhance gravitational blood flow through narrowed arteries, providing a potential neurological benefit.
The multicentre trial included 92 patients from 12 stroke centres across the US.
Patients were randomised to receive either 0-degree or 30-degree head positioning before thrombectomy surgery.
Neurological function was assessed using the National Institutes of Health Stroke Scale (NIHSS) to compare stability and clinical improvement between the two groups.
Interim analysis revealed that patients positioned with their heads flat experienced greater stability and clinical improvement before surgery compared to those with elevated head positioning.
Surprisingly, this benefit persisted at 24 hours post-surgery and upon discharge, with patients in the 0-degree group exhibiting fewer neurological deficits.
While the long-term outcomes at three months showed no significant difference between the two groups, patients in the 0-degree head positioning group were discharged with less disability, reducing the need for extensive rehabilitation.
Dr Alexandrov underscored that 0-degree head positioning is not a stroke treatment but rather a strategy to optimise blood flow temporarily until a thrombectomy can be performed.
The study’s Data and Safety Monitoring Board halted enrolment in November 2023 due to the efficacy of 0-degree head positioning.
The findings from the ZODIAC trial challenge current practices and suggest that flat head positioning should be considered the standard of care for stroke patients awaiting thrombectomy surgery.
While these results are promising, it’s essential to note that they are preliminary and subject to peer review.
Nevertheless, they represent a significant advancement in stroke care and could potentially improve patient outcomes worldwide.
Photo caption - Pic courtesy of American Heart Association
