2077 Reducing Mortality in Supratentorial ICHs: An ENRICH Post-Hoc Study

INTRODUCTION: The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial, which recently explored minimally invasive evacuation of intracerebral hemorrhage (ICH), demonstrated a relevant clinical improvement in functional outcomes and mortality compared to standard medical care particularly for lobar haemorrhages. METHODS: We included all patients from the ENRICH surgical cohort (n=150), assessed several variables, including the interval from last known normal (LKN) to surgery, surgeon’s experience, ICH volume before (preop ICH volume) and after treatment (EOTV) and the rate of target EOTV < 15 mL for predicting 180-day mortality. AUROC analysis and multivariable regression models were employed to determine relevant thresholds and significant predictors. RESULTS: Median LKN to surgery intervals were 17.78, 18.72 and 14.92 hours for the entire cohort, lobar, and ABG ICHs respectively, with a cut-off at 11.73 hours of LKN to surgery being associated with better outcomes and a 0.538 (0.427-0.649) AUROC. Mean preoperative ICH volumes were 54.39, 54.40 and 50.96 mL respectively, with a 0.678 (0.575-0.782) AUROC and a 62.75 mL threshold for better outcomes in the overall and lobar ICH cohorts and a 35.25 mL threshold for the ABG group. EOTVs (7.18, 6.90 and 7.72 mL, respectively) showed a 0.635(0.516-0.754) AUROC with a threshold of 30.42 mL overall, and a slightly inferior result for the ABG group (AUROC: 0.601[0.391-0.811]; threshold: 21.78 mL). Among these, only EOTV (OR: 1.02[1.004-1.04]) represented an independent predictor of mortality, other than age (OR: 1.06[1.01-1.10]) and preoperative GCS (OR: 0.82[0.68-0.98]); surgical experience was not predictive of mortality. CONCLUSIONS: Within ENRICH surgical participants optimal thresholds impacting mortality were established with regards to time-to-intervention, preoperative ICH volume, and EOTV. These findings might aid in optimizing patient selection and have significant implications for designing future clinical trials.