Abstract Body: Introduction
Pneumonia causes more deaths than neurological damage after stroke. Stroke-associated pneumonia is caused by aspiration of vomited/regurgitated gastric content. We assess whether metoclopramide, an antiemetic, prevents pneumonia and reduces mortality.

Methods
2100 adults within 24 hours of stroke onset, moderate to severe neurological impairment (NIHSS≥10) or dysphagia and NIHSS≥6, without pneumonia at screening, contraindications to metoclopramide, pregnancy, and life-limiting comorbidities will be recruited from 60 or more UK hospitals.

Patients will be randomised (1:1) by minimisation on age, mRS, NIHSS, type of centre and time from onset, to receive 10mg of MCL/placebo (normal saline 2ml) tds via injection or nasogastric tube for 14 days. Follow-up will be conducted at day 14 in person and at 6-months by telephone.

The primary outcome is all-cause mortality by 6 months. Secondary outcomes include pneumonia diagnosis, number of days of antibiotic treatment, quality of life (QOL), swallow, and neurological recovery at day 14 and mRS, frailty, QOL, swallow recovery, and home time at 6-months.


Results
As of 17^th October 2024, 1033 (49.0%) participants have been recruited to MAPS-2 trial from a total of 77 open sites in the UK.

Conclusions
MAPS-2 results will provide definitive evidence for the effectiveness of metoclopramide in reducing pneumonia and deaths after acute stroke.