Abstract NS2: Acute ICH Response (AIR) Team: Implementing a Hospital-Wide Acute Intracerebral Hemorrhage Response

Background: Early, coordinated response to spontaneous intracerebral hemorrhage (ICH) is critical for improving outcomes but is often delayed due to fragmented workflows. Our Comprehensive Stroke Center launched a structured Acute ICH Response (AIR) protocol to streamline multidisciplinary response and address care delays. Objective: Develop and implement a standardized, multidisciplinary AIR activation process for suspected spontaneous ICH, and evaluate feasibility and early impact of activation process. Methods: Internal- and external-facing AIR protocols were developed to support rapid ICH treatment. Internally, the process was developed collaboratively among stroke, neurosurgery, neurocritical care, ED, imaging, laboratory, and critical care teams. Preparations included educational sessions, EHR changes, and standardized order panels. Activation is triggered after ICH is confirmed on neuroimaging. A stroke nurse receives the AIR activation page and coordinates with the Neuro ICU, facilitating early care transition. Several of the workflows supporting team roles, transitions, and response timing are provided in Figures 1 and 2. Results: The first activation occurred within 48 hours of launch. Since go-live, 11 non-transfer patients with ICH have been managed under the AIR protocol. Compared to pre-AIR data (n=19), time from CT read to unit arrival improved significantly: median reduced from 2.58 to 0.28 hours (means: 5.57 vs. 0.50 hours) (Table 1). Among patients requiring BP-lowering therapy, median time to administration decreased from 28 to 8 minutes (means: 53 vs. 8 minutes). ICH reversal post-AIR median time was 20 minutes vs. 28 minutes pre-AIR. A single outlier (requiring pharmacy assistance during multiple intubations) raised the post-AIR mean to 53 minutes (pre-AIR mean: 25 min). The proportion receiving reversal increased from 15.8% to 27.3%, possibly reflecting improved recognition. Only three reversal cases have occurred since AIR go-live, and data collection is ongoing. We plan to present an expanded analysis at ISC 2026. Conclusion: The AIR protocol is a feasible and promising framework for rapid multidisciplinary response to spontaneous ICH. Early results show faster transitions, treatment initiation, and cross-team coordination. Future efforts will focus on data tracking, outcome measurement, and expansion to other facilities.