Abstract WP217: Code ICH Activation Improves Timeliness of Care and Outcomes in Intracerebral Hemorrhage: Early Experience at an Academic Medical Center

Background: Intracerebral hemorrhage (ICH) carries high morbidity and mortality, yet unlike acute ischemic stroke, there is no widely adopted time-sensitive protocol akin to a “code stroke.” The INTERACT3 trial showed that bundled interventions—rapid blood pressure control, anticoagulation reversal, temperature management, and glucose regulation—improve functional outcomes. In response, many centers have implemented “Code ICH” protocols. Our Comprehensive Stroke Center (CSC) launched such a protocol on February 25, 2025. We report its early impact. Methods: We retrospectively compared consecutive ICH cases during two six-month periods: pre-intervention (Mar 1–Aug 1, 2024) and post-intervention (Mar 1–Aug 1, 2025). Outcomes included time from computed tomography (CT) confirmation to Code ICH activation, achievement of BP goal within 60 minutes, timely anticoagulation reversal, and discharge disposition. Categorical outcomes were compared with two-proportion tests (chi-square or Fisher’s exact, as appropriate); continuous/interval times are reported as ranges or medians. Results: During the pre-intervention period, 38 patients were managed without a formal Code ICH protocol. Following implementation, 62 patients received bundled, time sensitive care. Median time from ICH confirmation to protocol activation ranged from 7-37 minutes. Timely stabilization of blood pressure within 60 minutes increased 35% to 57 % (p=0.033), while delays beyond 120 minutes decreased from 39%. Among anticoagulated patients, timely administration of reversal agents within 60 minutes improved from 33% to 60%, and delays of 61–90 minutes declined (33% to 10%). Mortality decreased from 44% to 22% (11/25 vs 5/23: p=0/13), a favorable trend but not statistically significant. Home discharges increased 11% to 39% (3/25 vs 9/23; p = 0.046). Discharges to inpatient rehabilitation remained unchanged. Conclusions: Implementing a Code ICH protocol at an academic CSC improved timeliness of key interventions—particularly BP control and anticoagulation reversal—and was associated with increased home discharge and a trend toward lower mortality. These findings support a team-based, time-sensitive approach to ICH care.