» Articles » PMID: 38149323

Acute Care Bundles Should Be Used for Patients with Intracerebral Haemorrhage: An Expert Consensus Statement

Abstract

Purpose: Intracerebral haemorrhage (ICH) is the most devastating form of stroke and a major cause of disability. Clinical trials of individual therapies have failed to definitively establish a specific beneficial treatment. However, clinical trials of introducing care bundles, with multiple therapies provided in parallel, appear to clearly reduce morbidity and mortality. Currently, not enough patients receive these interventions in the acute phase.

Methods: We convened an expert group to discuss best practices in ICH and to develop recommendations for bundled care that can be delivered in all settings that treat acute ICH, with a focus on European healthcare systems.

Findings: In this consensus paper, we argue for widespread implementation of formalised care bundles in ICH, including specific metrics for time to treatment and criteria for the consideration of neurosurgical therapy.

Discussion: There is an extraordinary opportunity to improve clinical care and clinical outcomes in this devastating disease. Substantial evidence already exists for a range of therapies that can and should be implemented now.

Citing Articles

Acute Stroke Units Nested within Broader Neurology: Care Bundles for Nursing to Enhance Competence and Interdisciplinary Coordination.

Klinke M, Thorarinsson B, Sveinsson O Curr Neurol Neurosci Rep. 2025; 25(1):21.

PMID: 40047971 PMC: 11885359. DOI: 10.1007/s11910-025-01409-7.


Incidence, case fatality, and functional outcome of intracerebral haemorrhage, according to age, sex, and country income level: a systematic review and meta-analysis.

Wolsink A, Cliteur M, van Asch C, Boogaarts H, Dammers R, Hannink G Lancet Reg Health Eur. 2025; 49:101180.

PMID: 39759582 PMC: 11699750. DOI: 10.1016/j.lanepe.2024.101180.


Urgent Reversal of Direct Oral Anticoagulants in Critical and Life-Threatening Bleeding: A Multidisciplinary Expert Consensus.

Rodrigues A, Goncalves L, Gregorio T, Baldaia C, Santo G, Gouveia J J Clin Med. 2024; 13(22).

PMID: 39597986 PMC: 11595216. DOI: 10.3390/jcm13226842.


Facial trauma with life-threatening bleeding treated by andexanet alfa administration: A case report.

Shirakawa Y, Jingami N, Ishiguro Y, Minami T, Shinozuka K, Yunoki T Heliyon. 2024; 10(17):e36922.

PMID: 39281456 PMC: 11402178. DOI: 10.1016/j.heliyon.2024.e36922.


Blood Pressure Management in Intracerebral Haemorrhage: when, how much, and for how long?.

Mutimer C, Yassi N, Wu T Curr Neurol Neurosci Rep. 2024; 24(7):181-189.

PMID: 38780706 PMC: 11199276. DOI: 10.1007/s11910-024-01341-2.

References
1.
Mendelow A, Gregson B, Rowan E, Murray G, Gholkar A, Mitchell P . Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013; 382(9890):397-408. PMC: 3906609. DOI: 10.1016/S0140-6736(13)60986-1. View

2.
Flibotte J, Hagan N, ODonnell J, Greenberg S, Rosand J . Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology. 2004; 63(6):1059-64. DOI: 10.1212/01.wnl.0000138428.40673.83. View

3.
Greenberg S, Ziai W, Cordonnier C, Dowlatshahi D, Francis B, Goldstein J . 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2022; 53(7):e282-e361. DOI: 10.1161/STR.0000000000000407. View

4.
Greer D, Funk S, Reaven N, Ouzounelli M, Uman G . Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke. 2008; 39(11):3029-35. DOI: 10.1161/STROKEAHA.108.521583. View

5.
Parry-Jones A, Sammut-Powell C, Paroutoglou K, Birleson E, Rowland J, Lee S . An Intracerebral Hemorrhage Care Bundle Is Associated with Lower Case Fatality. Ann Neurol. 2019; 86(4):495-503. PMC: 6771716. DOI: 10.1002/ana.25546. View