Eligibility

Local study conflicts

• None

Inclusion Criteria:

1. Adults (at least 18 years old) with a clinical diagnosis of acute stroke
2. Within 24 hours of symptom onset
3. Either criteria a or b below:
   1. Moderate to severe neurological impairment (NIHSS Score ≥ 10)
      OR
   2. Dysphagia and NIHSS ≥ 6, unable to take normal unmodified oral diet or fluids because or either:
   • Too drowsy to be assessed formally
     OR
   • Failed bedside assessment of swallowing

Exclusion Criteria:

1. Definite or probable pneumonia at screening
2. Contraindications to metoclopramide
3. Clinical indication for regular anti-emetic treatment
4. Known cirrhosis of the liver
5. Known severe renal dysfunction (eGFR < 30 ml/min)
6. Pregnant or breast-feeding
7. Moribund (expected to die within the next 48 hours)
8. Co-morbid conditions with life expectancy <3 months
9. Inability to gain consent (patient or legal representative) or consent declined

If the patient is eligible:

• Gain verbal agreement in principle before proceeding. Explain:
• Taking part in research is likely to improve the quality of their care
• Risks are carefully controlled - research is safe
• Explain the uncertainty that exists with respect to treatment of their condition
• If they change their mind they can withdraw their participation at any point

Step-by-Step Guide to Recruitment:

In standard working hours; 9-5

• Please contact the Stroke Research Team when eligible patients arrive in ED. Phone Cheryl 85114 or Muni 86653 The Stroke Research team will see the patient to arrange consent and randomisation.

Out of hours and weekends:

• We are not planning to recruit out of hours for the foreseeable future.
• If patient is admitted on a Sunday please email MRN to cheryl.padilla-harris@mkuh.nhs.uk and copy in wuraola.akande@mkuh.nhs.uk and patricia.avila@mkuh.nhs.uk, as we have 24 hours from Stroke Onset to recruit the patient. So they can be followed up by the team on Monday morning.

Further information

Link to trial site