Participants 396
Lesson 1 of 1
In Progress
Literature Review #24
Ma L, Hu X, Song L, et al. The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial. Lancet. Published online May 24, 2023:S0140-6736(23)00806-1.
PMID: 37245517
Background
- Intracerebral hemorrhage is the most serious and least treatable form of stroke
- The current focus on treatment involves normalization of physiologic abnormalities, particularly intensive blood pressure lowering and reversal of coagulopathies
STUDY OBJECTIVE
- Establish whether implementing a goal-directed care bundle incorporating protocols for early intensive blood pressure lowering and management algorithms for hyperglycemia, pyrexia, and abnormal anticoagulation could improve outcomes for acute, spontaneous, intracerebral hemorrhage
STUDY DESIGN
- International, multicenter, prospective, stepped wedge, cluster randomized, blinded, outcome assessed, controlled trial undertaken in primarily low- and middle-income countries
Study Intervention & Comparison
- Care bundle targeting normalization of blood pressure (SBP £140), blood glucose (110-140 or 140-180 if diabetic), body temperature (<37.5°C), and reversal of anticoagulation (INR <1.5) vs usual care
Results
- Primary Safety Outcome
- Poor functional outcome less likely in care bundle group (OR 0.86, CI 0.76-0.87, p=0.015
- Secondary Safety Outcome
- Fewer serious adverse events in care bundle group (16% v 20.1%, p=0.0098)
Summary
- The implementation of a care bundle protocol incorporating the early control of elevated blood pressure, blood glucose, and body temperature and correction of abnormal coagulation resulted in an improved functional outcome at 6 months.
Additional Readings
- Middleton S, McElduff P, Ward J, et al. Implementation of evidencebased treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet 2011; 378: 1699–706.
- ParryJones AR, SammutPowell C, Paroutoglou K, et al. Intracerebral hemorrhage care bundle is associated with lower case fatality. Ann Neurol 2019; 86: 495–503.
- Song L, Wang X, Ouyang M, et al. Associations of an abnormal physiological score with outcomes in acute intracerebral hemorrhage: INTERACT2 study. Stroke 2021; 52: 722–25.