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The Impact of Zero-Degree Head Positioning on Stroke Patients Before Thrombectomy

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Dr. Jessica Nelson
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The Impact of Zero-Degree Head Positioning on Stroke Patients Before Thrombectomy

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The ZODIAC Clinical Trial: A New Perspective on Stroke Care

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In an enlightening revelation for stroke care, a study presented at the American Stroke Association International Stroke Conference proposed that laying a stroke patient's head flat (0-degree head positioning) before thrombectomy could enhance neurological function. The study, conducted by researchers from the University of Tennessee Health Science Center in Memphis, demonstrated that 0-degree head positioning resulted in greater stability or clinical improvement compared to 30-degree head positioning. The trial, known as the ZODIAC clinical trial, included 92 participants from 12 stroke centers across the United States.

Zero-Degree Head Positioning: A Simple Yet Effective Strategy

The study discovered that stroke patients whose heads were positioned at 0 degrees elevation before surgery witnessed improved neurological function compared to those positioned at 30 degrees. The Data and Safety Monitoring Board even stopped enrollment in the study due to the demonstrated efficacy of 0-degree head positioning. This approach is considered a rescue manoeuvre to preserve brain function by optimizing blood flow to the brain until the thrombectomy can be performed. The lead researcher, Anne W. Alexandrov, PhD, firmly stated that zero-degree head positioning should be considered the standard of care for stroke patients prior to thrombectomy.

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A Closer Look at the ZODIAC Trial

The ZODIAC trial, led by Professor Anne Alexandrov at UT Health Science Center, funded by $2.3 million from the National Institute of Nursing Research, concluded that 0-degree head positioning is safe and improves outcomes for stroke patients prior to thrombectomy. The trial enrolled 92 patients at 12 sites over five years. The results showed that 0-degree head positioning reduced disability and clinical stability for patients, with significantly better improvement in neurological disability compared to the 30-degree group after the surgery.

The Clinical Benefits of Zero-Degree Head Positioning

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The ZODIAC trial revealed that laying large vessel occlusion (LVO) ischemic stroke patients flat with their heads at a zero-degree angle prior to a mechanical thrombectomy procedure resulted in significant short-term improvements in neurological function. Patients in the zero-degree head-position group had reduced disability and fewer neurological deficits compared to those in the 30-degree group at 24 hours and seven days/discharge. This positioning is considered critically important when immediate access to thrombectomy is unavailable, especially in LVO cases requiring hospital-to-hospital transfer for the procedure.

Long Term Outcomes and Rehabilitation

Although there was no difference in outcomes at three months, patients with 0-degree head positioning were discharged with less disability requiring rehabilitation. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate stroke patients and it was found that 0-degree head positioning resulted in greater stability and/or clinical improvement. These results underscore that zero-degree head positioning is a safe and effective strategy to optimize blood flow to the brain until the thrombectomy can be performed, reinforcing its status as a standard of care for stroke patients prior to thrombectomy.

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