WSC 2025 | The CODE-ICH protocol: the standardization and implementation of early care for ICH

The CODE-ICH protocol is a call to action to put forth a protocol that is similar to ischemic stroke to emphasize early treatment, bundled care, and time-based metrics for patients with intracerebral hemorrhage. Because for the ischemic stroke, there are well-established care bundles and systems, especially the quality control systems worldwide, to ensure timely treatment of ischemic stroke. However, such protocols are lacking for intracerebral hemorrhage. And time-based brain is also true for intracerebral hemorrhage. So we advocate for widespread implementation of early bundle care for intracerebral hemorrhage based on time-based metrics. And we hope that the CODE-ICH may endure as a structural platform for standardization, innovation, and implementation of early bundle care and treatment for patients with intracerebral hemorrhage for the years to come. There are several key components of CODE-ICH. First, to emphasize rapid imaging and triage for the patients. We should preferably do the CT scan within 25 minutes, and we should ask the history of any anticoagulant use in the emergency settings and implement care bundle in the early settings which include blood pressure control, anticoagulant reversal. So the time limit for anticoagulant reversal is preferably within 60 minutes for every patient with the anticoagulant-associated ICH and we should control the blood pressure within 60 minutes for every patient with the anticoagulant-associated ICH. And we should control the blood pressure within 60 minutes after the patient arrives in the hospital. And we should also look for glycemic control and temperature management, etc.

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