Bundled Care Interventions for the Management of Intracerebral Hemorrhage: A Review

BACKGROUND: Spontaneous intracerebral hemorrhage affects approximately 80 000 people in the United States annually and is associated with significant risk of disability and mortality. As with many acute conditions, protocolized care has been shown to benefit patients with intracerebral hemorrhage. The 2024 American Heart Association/American Stroke Association guidance document for intracerebral hemorrhage management recommends bundled care interventions, including timely blood pressure control, anticoagulation reversal, and surgical intervention to improve outcomes. OBJECTIVE: To assess the rationale for and literature pertaining to the recommended bundled care interventions for intracerebral hemorrhage management and offer practical guidance for nurses to optimize patient care. METHODS: The recommendations in the 2024 American Heart Association/American Stroke Association guidance document for intracerebral hemorrhage management were reviewed, the literature supporting bundled care interventions was assessed, and a narrative review of this information was generated. RESULTS: Protocolized care has shown benefit for many devastating conditions, including acute ischemic stroke. Recent guidelines and evidence suggest that this kind of intervention may also improve outcomes for intracerebral hemorrhage patients. The critical care nurse has a significant role to play in facilitating timely interventions for intracerebral hemorrhage patients, particularly regarding neurologic status changes and blood pressure control. Further study is needed to determine the most appropriate timing and targets for the best outcomes. CONCLUSION: Recent evidence and guidance documents support the use of bundled care protocols to improve outcomes for individuals experiencing intracerebral hemorrhage. Early recognition of intracerebral hemorrhage and knowledge of bundled care interventions may benefit these patients and improve outcomes.