Advances in Prehospital Management of Intracerebral Hemorrhage

Abstract

Background: Spontaneous acute intracerebral hemorrhage (ICH) is associated with greater stroke-related disability and mortality than acute ischemic stroke. Hematoma expansion (HME), an important treatment target in acute ICH, is time-dependent, with a greater probability of hematoma growth occurring Summary: Promising treatment options to reduce HME include early intensive blood pressure reduction and the administration of hemostatic or anticoagulant reversal agents, yet large phase III clinical trials have so far failed to show overwhelming benefit for these interventions in acute ICH. Post hoc analyses provide evidence, however, that the therapeutic benefit of such treatments is enhanced by rapid and ultra-early intervention, likely driven in large part by attenuation of early HME. Clinical trials assessing ultra-rapid treatments (Key Messages: Ultra-early interventions in acute ICH are likely necessary to mitigate the risk of HME, and as such, the prehospital setting is ideal to initiate time-sensitive ICH therapies. Reliable prehospital acute ICH detection is essential to provide disease-specific treatments. Overall, it is imperative that “Time is Brain” become the mantra not only for ischemic stroke but for ICH as well, and that the promise of ultra-early therapies for ICH be translated into concrete benefits for patients with this devastating condition.