Application of bundle of care for spontaneous intracerebral hemorrhage in the real world: effect on hematoma expansion and functional outcome.

Background: Bundle care has recently been the topic of expert consensus statements for optimal management of ICH. The aim of the present study was to assess the application of each intervention of these bundles of care and their combination in the real world and their effect on functional outcome and hematoma expansion.

Methods: We analyzed data from 273 patients with spontaneous ICH who were consecutively admitted to AOUI Verona between January 2022 and June 2024. The components of the bundle of care were the following: (A) door-to-reversal agent administration ≤ 60 min, (B) systolic blood pressure (SBP) target (≤ 140 mmHg), (C) blood glucose (BG) target (108-140 mg/dL in non-diabetic patients and 140-180 mg/dL in diabetic patients), and 4) body temperature (BT) target (≤ 37,5 °C) ≤ 60 min. The primary endpoint was 3-month mRS 0-2. Secondary endpoints were the following: (a) 3-month mortality, (b) 24-hour severe hematoma expansion, (c) 3-month mRS 0-2 in survivors.

Results: BP target (≤ 140 mmHg) ≤ 60 min was associated with higher rate of mRS 0-2 (aOR:4.795; 95% CI:1.343-17.120; p = 0.016) (third model of adjustment for unbalanced variables), lower rate of severe hematoma expansion (aOR:0.254, 95% CI:0.070-0.928; p = 0.038) and higher rate of mRS 0-2 in survivors (aOR:4.445; 95% CI:1.358-13.548; p = 0.014), and BG target ≤ 60 min was associated with lower rate of mortality (aOR:0.290, 95% CI:0.088-0.948; p = 0.041) (adjustment for pre-defined variables).

Conclusions: Early intensive SBP control is the most effective intervention of the bundle of care for improving functional outcomes and reducing hematoma expansion. Early intensive BG control is effective in reducing mortality.