Code ICH: A Call to Action

Authors

Qi Li, The Second Affiliated Hospital of Anhui Medical University, Hefei, China (Q.L.).
Aleksandra Yakhkind, Tufts University School of Medicine, Boston, MA (A.Y.).
Anne W. Alexandrov, University of Tennessee Health Science Center, Memphis (A.W.A.).
Andrei V. Alexandrov, University of Arizona College of Medicine, Phoenix (A.V.A.).
Craig S. Anderson, The George Institute for Global Heath, University of New South Wales, Sydney, Australia (C.S.A.).Follow
Dar Dowlatshahi, University of Ottawa and Ottawa Hospital Research Institute, Canada (D.D.).
Jennifer A. Frontera, New York University Grossman School of Medicine (J.A.F.).
J Claude Hemphill, University of California San Francisco (J.C.H.).
Latha Ganti, University of Central Florida College of Medicine, Orlando (L.G.).
Chris Kellner, Icahn School of Medicine at Mount Sinai (C.K.).
Casey May, The Ohio State University College of Pharmacy, Columbus (C.M.).
Andrea Morotti, University of Brescia, Italy (A.M.).
Adrian Parry-Jones, University of Manchester, United Kingdom (A.P.-J.).
Kevin N. Sheth, Yale University School of Medicine, New Haven, CT (K.N.S.).
Thorsten Steiner, Department of Neurology, Klinikum Frankfurt, Germany (T.S.).
Wendy Ziai, John Hopkins University School of Medicine, Baltimore, MD (W.Z.).
Joshua N. Goldstein, Harvard Medical School, Boston, MA (J.N.G.).
Stephan A. Mayer, New York Medical College, Valhalla (S.A.M.).Follow

Author Type(s)

Faculty

DOI

10.1161/STROKEAHA.123.043033

Journal Title

Stroke

First Page

494

Last Page

505

Document Type

Article

Publication Date

2-1-2024

Department

Neurology

Abstract

Intracerebral hemorrhage is the most serious type of stroke, leading to high rates of severe disability and mortality. Hematoma expansion is an independent predictor of poor functional outcome and is a compelling target for intervention. For decades, randomized trials aimed at decreasing hematoma expansion through single interventions have failed to meet their primary outcomes of statistically significant improvement in neurological outcomes. A wide range of evidence suggests that ultra-early bundled care, with multiple simultaneous interventions in the acute phase, offers the best hope of limiting hematoma expansion and improving functional recovery. Patients with intracerebral hemorrhage who fail to receive early aggressive care have worse outcomes, suggesting that an important treatment opportunity exists. This consensus statement puts forth a call to action to establish a protocol for Code ICH, similar to current strategies used for the management of acute ischemic stroke, through which early intervention, bundled care, and time-based metrics have substantially improved neurological outcomes. Based on current evidence, we advocate for the widespread adoption of an early bundle of care for patients with intracerebral hemorrhage focused on time-based metrics for blood pressure control and emergency reversal of anticoagulation, with the goal of optimizing the benefit of these already widely used interventions. We hope Code ICH will endure as a structural platform for continued innovation, standardization of best practices, and ongoing quality improvement for years to come.

Recommended Citation

Li, Q., Yakhkind, A., Alexandrov, A. W., Alexandrov, A. V., Anderson, C. S., Dowlatshahi, D., Frontera, J. A., Hemphill, J. C., Ganti, L., Kellner, C., May, C., Morotti, A., Parry-Jones, A., Sheth, K. N., Steiner, T., Ziai, W., Goldstein, J. N., & Mayer, S. A. (2024). Code ICH: A Call to Action. Stroke, 55 (2), 494-505. https://doi.org/10.1161/STROKEAHA.123.043033