Code ICH: A Call to Action

Area of Science:

• Neurology
• Emergency Medicine
• Stroke Research

Background:

• Intracerebral hemorrhage (ICH) is a severe stroke type with high mortality and disability rates.
• Hematoma expansion independently predicts poor functional outcomes in ICH patients.
• Previous trials of single interventions to reduce hematoma expansion have largely failed.

Purpose of the Study:

• To advocate for the adoption of a bundled care protocol, termed "Code ICH," for intracerebral hemorrhage.
• To improve functional recovery and limit hematoma expansion through ultra-early, simultaneous interventions.
• To establish a standardized, time-sensitive approach for ICH management, mirroring successful acute ischemic stroke protocols.

Main Methods:

• Review of existing evidence on ICH management and hematoma expansion.
• Proposal of a consensus-based "Code ICH" protocol.
• Emphasis on time-based metrics for blood pressure control and anticoagulation reversal.

Main Results:

• Ultra-early bundled care demonstrates potential for limiting hematoma expansion and improving functional recovery.
• Delayed or inadequate aggressive care in the acute phase is associated with worse patient outcomes.
• Existing interventions like blood pressure control and anticoagulation reversal can be optimized within a bundled care framework.

Conclusions:

• A "Code ICH" protocol, integrating bundled care and time-based metrics, is essential for improving outcomes.
• Standardized, early interventions are critical for optimizing the treatment of intracerebral hemorrhage.
• This framework aims to foster innovation, standardize best practices, and drive quality improvement in ICH care.