LONGECITY

Let me start off by saying that I've been EMT certified for barely a year now and am studying to be a paramedic. My skills in the theoretical world far exceed my abilities in the field. Still, after perusing these forums for a while and going out in the field, I've realized that there's the potential for brain tissue (read: functional lives) to be saved.
The prehospital treatment for stroke is only supportive. High flow oxygen, fluid bolus, rapid transport, neuro assessment if you have the time to do it. Even once you get to the ED, the damage is more or less done; what's left is to assess and treat it. Similarly, in the scenario of cardiac arrest, particularly where the patient has been dead for a significant period of time, there is little that can be done to salvage brain tissue. Only the return of spontaneous circulation (and artificial circulation by chest compressions in the meantime) and hyperoxygenation can try and save ischemic brain tissue. What about piracetam? Piracetam seems like the perfect second line code drug, and a first line drug for other indications of cerebral ischemia. It's cheap, it can be administered parenterally, it has a high safety profile, and it's only major contraindication is renal failure (which is a contraindication to half the PDR...). It shows significant promise for recovery of ischemic brain tissue, which directly correlates not only with survival as a whole but also quality of life after the fact. Has anybody heard anything about piracetam in EMS or the emergency setting, or any reasons why it shouldn't be used?

Let me start off by saying that I've been EMT certified for barely a year now and am studying to be a paramedic. My skills in the theoretical world far exceed my abilities in the field. Still, after perusing these forums for a while and going out in the field, I've realized that there's the potential for brain tissue (read: functional lives) to be saved.
The prehospital treatment for stroke is only supportive. High flow oxygen, fluid bolus, rapid transport, neuro assessment if you have the time to do it. Even once you get to the ED, the damage is more or less done; what's left is to assess and treat it. Similarly, in the scenario of cardiac arrest, particularly where the patient has been dead for a significant period of time, there is little that can be done to salvage brain tissue. Only the return of spontaneous circulation (and artificial circulation by chest compressions in the meantime) and hyperoxygenation can try and save ischemic brain tissue. What about piracetam? Piracetam seems like the perfect second line code drug, and a first line drug for other indications of cerebral ischemia. It's cheap, it can be administered parenterally, it has a high safety profile, and it's only major contraindication is renal failure (which is a contraindication to half the PDR...). It shows significant promise for recovery of ischemic brain tissue, which directly correlates not only with survival as a whole but also quality of life after the fact. Has anybody heard anything about piracetam in EMS or the emergency setting, or any reasons why it shouldn't be used?

Most of the study, and the general impression that i'm under, is that the documented benefits of piracitam have been shown to occur over time periods of more then a day.

http://www.piracetam...piracetam-9.htm

Maybe of interest.

I'm aware that the onset appears delayed; but firstly, administering the medication as soon as possible would mean reaching as much hypoxic tissue as possible (as opposed to tissue that has already necrosed). Secondly, the studies fail to mention whether the route is enteral or parenteral-- the onset of intravenous drugs is far faster than oral drugs, and tends to have higher bioavailability (assuming the drug itself is responsible for the effect, not its metabolites). Unfortunately I have seen some apocryphal material on the web about piracetam aggravating hemorrhaging, which makes neuro issues tough because they can be either clots or bleeds; but then again, this is the same dilemma faced with fibrinolytics.

I agree with this; i don't notice much from pir, but i take it everyday as a prophylactic against damage caused by an accident.

The protection from ischemia seems to be an acute effect, actually.

But it might be important whether or not the piracetam is present BEFORE the injury. As we know, certain substances (NAC) seem to have the potential of having opposite effects if they're administered at the wrong time.

More study is needed, really.