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• 18 years or older
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• Premorbid modified Rankin Score of 3, 4 or 5
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• Recruited within 24 hours of stroke onset
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• Deterioration within first hour of admission, resulting in direct admission to ICU, a documented clinical decision for palliative treatment, or immediate surgery
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• Admitted to stroke care unit
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• Conscious – reacts to verbal commands as a minimum
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• Concurrent diagnosis of rapidly deteriorating disease (e.g. terminal cancer)
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• Unstable coronary or other medical condition judged by investigator to impose hazard to patient if involved in trial
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• Systolic blood pressure < 110 or > 220 mmHg
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• Oxygen saturation < 92% (±supplemental oxygen)
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• Resting heart rate < 40 or >110 bpm
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• Temperature > 38.5°C
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• Enrolled in another intervention trial
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