Episode 53 - Intracranial Hemorrhage

We cover a post by Dr. Rory Spiegel, EMNerd: The Case of Differing Perspectives, on the results of the ATACH-2 trial on blood pressure control in intracranial hemorrhage (ICH). This study sought to determine the safety and efficacy of the Population: adults (>18 y/o) with ICH on CT scan, GCS ≥ 5 and Intervention: Reduce and maintain the hourly minimum systolic blood pressure in the range of 110 to 139 mm Hg throughout the period of 24 hours after randomization ("intensive treatment"). Preferred agents for blood pressure control in order of preference were 1. nicardipine 2. labetalol (diltiazem or urapidil if not available) Mean minimum in hours 0-2: 128.9±16 mm Hg Control: Reduce and maintain the hourly minimum systolic blood pressure in the range of 140 to 179 mm Hg throughout the period of 24 hours after randomization. Mean minimum in hours 0-2: 141.1±14.8 mm Hg Outcome: The primary outcome was the proportion of patients who had moderately severe or severe disability (modified Rankin scale score (mRS) 4-5) or those who had died (mRS 6; hereafter referred to as “death or disability”) at 3 months. death or disability: Intensive treatment = 186 participants (38.7%) vs Standard treatment = 181 (37.7%) We also discuss the history of blood pressure control in ICH and the pendulum swing on this in recent years, using an episode of the Skeptic's Guide to Emergency Medicine, Episode 73. This episode covers the Interact-2 trial. Core Content We delve into core content on ICH using Rosen’s (8th ed) Chapter  and Chapter in Tintinalli (8th ed). We also discuss the PATCH trial with regard to ICH management in patients on antiplatelet agents, discussing a REBELEM post on this trial.