A Call for Urgent Action to Redefine Stroke Protocols: Stephan A. Mayer, MD, FCCM, FNCS


The director of neurocritical care and emergency neurology services at Westchester Medical Center Health System talked about a recently published paper that highlighted the need to address the disparity in quality metrics for stroke care, especially for intracerebral hemorrhage. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

"Well, the trend that's happening right now is what we call ‘care bundles.’ Care bundles [are] when you do a couple of crucial things in parallel at the same time, especially for medical emergency, like intracerebral hemorrhage.”

Intracerebral hemorrhage (ICH), a condition caused by rupture of a cerebral vessel and entry of blood into the brain parenchyma, is a major contributor to stroke-related mortality and dependency. According to a recent review published in Nature Reviews Disease Primers, only half of patients who experience ICH survive for 1 year, and those who survive have sequelae that impacts their quality of life.1 Despite improvement of identification of the causes of ICH in the past decade, there remains no specific treatment available for patients.

A new report published in the journal Stroke by an international panel of experts in ICH care stated that quality improvement efforts in the emergency management of ICH should be a priority for patients. The consensus statement suggested that a protocol for Code ICH is needed, similar to used strategies for acute ischemic stroke, which may provide a framework for future research and innovation in the treatment of ICH.2 The panel of experts, which ranged across several countries worldwide, reviewed the latest evidence for treating ICH supporting the effectiveness of various strategies. These strategies included lowering of elevated blood pressure, reversal of blood thinners, treatment for brain swelling, and surgical hematoma removal.

Cosenior author Stephan A. Mayer, MD, FCCM, FNCS, director of neurocritical care and emergency neurology services at Westchester Medical Center Health System, recently sat down in an interview with NeurologyLive® to discuss how the disparities in quality metrics for acute ischemic stroke need be addressed to improve patient outcomes. Mayer, who also serves as a professor of neurology and neurosurgery at New York Medical College, talked about how findings from the INTERACT 3 trial have impacted the implementation of care bundles for ICH. In addition, he explained why there is a call for a standardized 'Code ICH' protocol with a 60-minute door-to-needle target time, and how it may impact stroke care overall.

1. Puy L, Parry-Jones AR, Sandset EC, Dowlatshahi D, Ziai W, Cordonnier C. Intracerebral haemorrhage. Nat Rev Dis Primers. 2023;9(1):14. Published 2023 Mar 16. doi:10.1038/s41572-023-00424-7
2. Li Q, Yakhkind A, Alexandrov AW, et al. Code ICH: A Call to Action. Stroke. Published online December 15, 2023. doi:10.1161/STROKEAHA.123.043033
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