Research in context
Cerebral Haemorrhage, fever, intracerebral haemorrhage, swallowing dysfunction, acute stroke
ACUTE STROKE, INTRACEREBRAL HAEMORRHAGE, ISCHAEMIC STROKE, BLOOD, CEREBRAL HAEMORRHAGE, DISEASE, HAEMORRHAGIC STROKE, HYPERGLYCAEMIA, ACUTE STROKE

We searched PubMed (from Jan 1, 1970, to Oct 30, 2022) and Embase (from Jan 1, 1947, to Oct 30, 2022), with no language or data restrictions, on Nov 24, 2022, for publications with relevant text words in the title or abstract or keywords that included: “intracerebral haemorrhage” OR “haemorrhagic stroke”, “care bundle” OR “treatment combination”, “blood pressure” OR “blood pressure lowering”, “blood glucose” OR “hyperglycaemia”, “body temperature”, and “anticoagulation reversal”. Studies were eligible for inclusion if they assessed the effectiveness of a combination of treatments on clinical outcomes. We identified only one completed cluster randomised controlled trial, done in 2011, the Quality in Acute Stroke Care trial, which showed that a combined protocol to manage fever, hyperglycaemia, and swallowing dysfunction improved the functional outcome in patients with acute stroke (both intracerebral haemorrhage and ischaemic stroke). A 2019 study in Salford, UK, showed a significant association between the implementation of a care bundle of anticoagulation reversal, blood pressure control, and rapid access to neurosurgery and improved survival after cerebral haemorrhage. The 2011 trial did not include blood pressure lowering in the protocol and there were few cases of intracerebral haemorrhage, whereas the 2019 study was limited by its before-and-after design. No ongoing trials were identified through a search of registered trials at 
The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial is the only randomised controlled trial involving a care bundle that included intensive blood pressure lowering treatment in acute intracerebral haemorrhage. The primary result was that the implementation of the care bundle across participating hospitals resulted in patients having a better functional outcome (measured on the modified Rankin Scale) at 6 months post-treatment compared with usual care. This result included favourable effects on survival and health-related quality of life. The results could not be explained by temporal trends in the characteristics of the patients or their management.
A simple, time-sensitive, goal-directed, care bundle protocol, with a foundation strategy of early intensive blood pressure management to a systolic blood pressure target of less than 140 mm Hg, was safe and effective in improving the functional outcome of acute intracerebral haemorrhage. These results provide a clear implication for the rapid control of blood pressure and other physiological variables to be incorporated into clinical practice as a part of active management for this serious disease.