New Study Urges Changes to Hemorrhagic Stroke Standards to Save Lives
Protocols for Intracerebral Hemorrhage, One of the Deadliest and Most Disabling Diseases in the World, Lags Far Behind Those for More Common Strokes Caused by Arterial Blockages
Intracerebral hemorrhage (ICH) is a serious medical emergency caused by the spontaneous rupture of a small artery in the brain, resulting in bleeding into the brain. Although ICH accounts for only 15 to 20 percent of all strokes, it is by far the deadliest and most disabling form of stroke, with a mortality rate of approximately 30 percent.
While a highly standardized and optimized workflow has been adopted worldwide for treating acute ischemic stroke – which is caused by arterial blockages – no such time-based emergency protocols are in widespread use for ICH. Stephan Mayer, M.D., professor of neurology and neurosurgery, along with an international consortium of doctors, is now urging this to change, in a study published in Stroke.
“Neurologists typically cite the phrase ‘time is brain’ to educate the public about the importance of acting quickly when someone is suspected of having a stroke,” says Dr. Mayer, co-senior author of the paper. “The fact of the matter is that this principle is unevenly applied. Hospitals are required to treat ischemic stroke urgently and report their performance but are under no obligation to do the same for ICH, even though it’s a more deadly disease. This disconnect must change.”
The paper, entitled “Code-ICH: A Call to Action,” reviews the latest scientific evidence supporting the effectiveness of various strategies for treating ICH. These include lowering of elevated blood pressure, reversal of blood thinners, treatment for brain swelling, and surgical hematoma removal. Based on the current evidence, they advocate for the immediate and widespread adoption of a “care bundle” designed to reduce blood pressure and reverse the effects of blood thinners within an hour of arrival to the hospital.
“ICH is an emergency and should be treated as one,” adds Joshua N. Goldstein, M.D., professor of emergency medicine at the Harvard Medical School and the co-senior author of the paper. “We know that during the first hours after a brain hemorrhage there is active bleeding that causes continued damage in up to 40 percent of patients. Stroke centers regularly treat hypertension and reverse anticoagulation, but there are currently no standards or requirements to give these treatments as quickly as possible.”
“Care bundles that emphasize ultra-early intervention for ICH have been studied; they dramatically reduce treatment times and improve outcomes,” adds Qi Li, M.D., Ph.D., chair of neurology at The Second Affiliated Hospital of Anhui Medical University, Hefei, China, and first author of the paper. “Evidence-based guidelines from professional organizations are used to codify best practices, but they can take years to develop. We wrote this consensus statement because our patients can’t wait that long. ICH is a life and death situation, and the time to act is now.”
The author group includes 18 experts in ICH care representing the United States, Canada, China, Australia, Italy, the United Kingdom, and Germany.