(New recommendation) Supratentorial hematoma evacuation in deteriorating patients might be considered as a life-saving measure (Class IIb; Level of Evidence C). (New recommendation) DC with or without hematoma evacuation might reduce mortality for patients with supratentorial ICH who are in a coma, have large hematomas with significant midline shift, or have elevated ICP refrac- tory to medical management (Class IIb; Level of Evidence C). (New recommendation) The effectiveness of minimally invasive clot evacuation with stereotactic or endoscopic aspiration with or with- out thrombolytic usage is uncertain (Class IIb; Level of Evidence B). (Revised from the previous guideline) Outcome Prediction and Withdrawal of Technological Support Observational and epidemiological studies have identified a wide range of factors associated with outcome after acute ICH; identification of these factors led to the development of models to predict mortality and functional outcome. These prediction models include individual patient characteristics such as score on the GCS or NIHSS, age, hematoma volume and location, and the presence and amount of IVH.26,30,249 256 None of these prediction models, however, account for the impact of care limitations such as do-not-attempt-resuscitation (DNAR) orders or the withdrawal of technological support. Most patients who die of ICH do so during the initial acute hospitalization, and these deaths usually occur in the setting of withdrawal of support because of presumed poor Palliative care is an important aspect of care for patients with severe ICH and their families whether or not withdrawal of support is being pursued, and this is discussed in substantially more detail in the recently released American Heart Association scientific statement on Palliative and End- of-Life Care in Stroke. 