Here’s an interesting OP-ED by a group of esteemed neurointensivists exploring the benefits for SABI pts when treated in a dedicated neuro-ICU

link.springer.com/article/10.100…

Even more evidence that door-to-needle time for BP control in acute #ICH matters.

In this pooled analysis of RCT data (>5000 pts) earlier and sustained SBP control <140 was associated w/ better outcome

ahajournals.org/do/10.1161/blo…

More evidence supporting the #CodeICH concept. Though the overall outcome in the INTERACT-4 trial of prehospital BP reduction in in ambulances showed no effext on outcome overall, mRS acores WERE better with BP reduction among the almost half of patients with #ICH ! See below:

It's not the lack of intelligence, it's the lack of focus that is stopping you.

We are one step closer! Neuro protection is definitely the next frontier is stroke care. Which agent and how to apply it is still to be determined.

In the SWITCH trial ~200 #ICH patients with large (mean 57 ml) deep bleeds were randomized to hemicraniectomy versus medical management.

Poor outcome (mRS 5-6) occured in 44% of those in the surgical arm vs 58% in the medical arm (just missed significance. But most survivors

Stroke intervention, be it lyrics, thrombectomy, or both, is increasing in this analysis of nationwide data from 2010-2020.

The good news is that mortality, discharge to home, and hospital length of stay have all been falling in parallel

#missionthrombectomy

I dunno. In this meta analysis of 2 RCTs, anticoagulation decreased the risk of death, recurrent stroke, or major bleeding from 4.4% to 1.4% (P=0.06)

If you have a carotid or vertebral dissection, what you you want to be treated with?

jamanetwork.com/journals/jaman…

This might be the future of neuromonitoring.

As your brain becomes severely more injured, heart rate and BP variability is reduced as auto regulation fails. In brain death there is no HR variability at all.

In this study of #SAH patients reduced HR, BP, and ICP variability

In case you were wondering, thrombectomy improves not only functional outcome but also cognitive status after #LVO #AIS

neurology.org/doi/abs/10.121…

ANEXXA-I is out. Andexanet alfa was superior to 'usual care' (85% use of a 4F-PCC) for control of hematoma expansion in DOAC-related #ICH . The problem is there is an increased rate of thrombotic events (mostly cerebral infarction). The next step is to figure what what the risk

In this propensity-matched observational study prehospital osmotherapy with hypertonic saline in TBI patients with a blown pupil (GCS 4) was associated with lower ICU mortality compared to initial treatment w/ mannitol.

Probably because HTS boosts CPP.

So get that central line

Nice X post on th ANNEXA-I trial comparing Andexanet alfa to standard of care (basically PCC) with DOAC-related inntracranial bleeding

The #CodeICH movement continues to make a splash as hospitals are adopting time-based quality metrics for BP control and emergency reversal. Check out this article detailing the ground swell in currents, the official newsletter of #NCS Neurocritical Care Society

currents.neurocriticalcare.org/Leading-Insigh…

Cool study of long-term outcomes after #ICH . With over 5 years of follow-up: mortality plateaus at 90 days but functional outcomes improve significantly between 6 and 12 months. Implications for trial design. rdcu.be/dHNwq Neurocritical Care Society Neurocritical Care

In this Chinese trial of 3000 pts with mild-moderate AIS, ASA and clopidogrel was superior to ASA alone for preventing neuroworseng within the 1st 7 days (4.8% vs 6.7%) with no increase in bleeding

Maybe a new standard of care?

jamanetwork.com/journals/jaman…

Humbled to have co-led this trial showing benefit of MT in early presenting pts with unlimitedly large infarcts.
Large core regardless of size = poor prognosis, but not treatment effect modifier.
IMAGING CANNOT IDENTIFY PTS WHO DON'T BENEFIT FROM MT !!

nejm.org/doi/full/10.10…

ICH after thrombectomy is predicted by — drum roll please — a larger prretrestment core (CBF <30%)

ajnr.org/content/early/…

Hemoglobin drift — aka “crit” attrition — is linked to higher mortality after #SAH . But this in NO way means that blood transfusions will improve outcome.

This anemia likely is a downstream effect of prolonged SIRS, which blood products might only make worse (e.g. ⬆️ ⚰️in the