Where Should Critically Ill Neurologic Brain Hemorrhage Patients Go and Can Transfer Harm Them?

Abstract

The brain is a complex organ subjected to acute neurological emergencies requiring rapid specialized care. With the advent of rTPA for acute ischemic stroke, the concept of aggressive intervention in neurological emergencies has grown to encompass other types of neurological emergencies such as intracranial hemorrhage and traumatic brain injury. This change has been fueled by the emergence of specialists who run and work in specialty units like the Neurocritical care unit (NCCU). These units have been shown to reduce morbidity, mortality, and the length of stay for critically ill neurologic patients [1–3]. The improved care in these units is driven by two underlying factors. The availability of technological interventions that are performed in the context of neurological specialty units and the concentration of neurological patients in a single location were the judgment and experience of specialty providers results in better outcomes [1–3]. Brain hemorrhage of all types, including intracranial (ICH) and aneurysmal subarachnoid (aSAH), is a subset of acute neurological emergencies for which truly definitive neurological care is now done in the setting of the NCCU. As we see the convergence of patients suffering from brain hemorrhages into the NCCU, issues arise pertaining to the need to transfer these patients to the NCCU in a rapid manner. What is the effect of urgent treatment in the NCCU on improved outcome for these neurological emergencies? Does the risk of transfer, or delay of transfer, affect outcomes? Three articles published in Neurocritical care present findings which raise questions about the effects of transfer and delay of transfer on outcomes in patients with ICH and aSAH.