NYMC Faculty Publications

Code-ICH: Time Is Brain

Author Type(s)

Faculty

DOI

10.1097/MCC.0000000000001244

Journal Title

Current Opinion in Critical Care

First Page

112

Last Page

116

Document Type

Article

Publication Date

4-1-2025

Department

Neurology

Keywords

acute care neurology, bundled care, hematoma expansion, hemostasis control, intracerebral hemorrhage

Disciplines

Medicine and Health Sciences

Abstract

Purpose of reviewIntracerebral hemorrhage (ICH) is the most devastating type of stroke resulting in severe disability and mortality. This review summarizes the emerging body of evidence supporting a new paradigm for care of patients called Code-ICH. It highlights the need for the adoption of time-based care bundles based on recent evidence, akin to those used in the management of acute ischemic stroke.Recent findingsNumerous trials aimed at decreasing hematoma expansion through single interventions have historically failed to show significant effects on primary outcomes. Time-sensitive, multifaceted, bundled care approaches have emerged with substantial promise in improving functional outcomes in patients with ICH. These bundles include early aggressive control of blood pressure and reversal of anticoagulation, strict normalization of blood sugar and temperature, early surgical evaluation, and minimizing early withdrawal of care.SummaryThe paradigm of Code-ICH empowers acute care providers to continuously measure system performance, reflect on best practices, improve outcomes, and tackle disparities for patients with ICH.

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