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Recommendations for Implementing the INTERACT3 Care Bundle for Intracerebral Hemorrhage in Latin America: Results of
Ma Ignacia Allende1, Paula Muñoz-Venturelli2,3,4, Francisca Gonzalez2,5
1Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile, m.allendee@udd.cl.
Insights
Consensus recommendations were developed to integrate the INTERACT3 care bundle for acute intracerebral hemorrhage (ICH) in Latin America. This aims to improve patient outcomes and reduce care disparities across the region.
Area of Science:
- Neurology
- Public Health
- Healthcare Management
Background:
- Acute intracerebral hemorrhage (ICH) management can be improved with care bundles.
- The INTERACT3 trial demonstrated the efficacy of a specific care bundle.
- Latin American countries face challenges in implementing standardized ICH care.
Purpose of the Study:
- To establish consensus-based recommendations for integrating the INTERACT3 care bundle in Latin America.
- To address disparities in ICH outcomes within the region.
- To guide the broader implementation of evidence-based ICH management.
Main Methods:
- A 3-phase Delphi study involving 32 healthcare professionals from 14 Latin American countries.
- Panelists ranked statements across 7 domains: training, resources, patient education, blood pressure, temperature, glycemic control, and anticoagulation reversal.
- Consensus was defined as 75% agreement.
Main Results:
- 43 statements reached consensus, with 12 new statements identified.
- Highest priorities included continuous healthcare worker training, resource-aligned protocols, and interdisciplinary care.
- Anticoagulation reversal strategies were identified as a high-priority area.
Conclusions:
- Consensus statements provide a framework for integrating the INTERACT3 care bundle in Latin America.
- Implementation requires addressing resourcing and training needs.
- These recommendations aim to reduce disparities in ICH outcomes across the region.
Introduction:
The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3) showed that the implementation of a care bundle improves outcomes after acute intracerebral hemorrhage (ICH). We aimed to establish consensus-based recommendations for the broader integration of the care bundle across Latin American countries (LAC).
Methods:
A 3-phase Delphi study allowed a panel of 32 healthcare workers from 14 LAC to sequentially rank statements relevant to 7 domains (training, resources/infrastructure, patient education, blood pressure, temperature, glycemic control, and anticoagulation reversal). The pre-defined consensus threshold was 75%.
Results:
A total of 43 statements reached consensus by the third round, with 12 new statements emerging through rounds. The highest-ranked statements in each domain emphasized critical aspects, but successful implementation requires appropriate resourcing. Key priorities were continuous training of all healthcare workers in ICH management, establishing protocols aligned with available resources, and collaborative interdisciplinary care supported by institutional networks. Statements related to anticoagulation reversal had the highest priority.
Conclusions:
Consensus statements are provided to facilitate integration of the INTERACT3 care bundle to reduce disparities in ICH outcomes in LAC.
