Across our network, we’ve seen again and again how clarity, coordination and courage can transform stroke care.
This month, that spirit turns toward one of the toughest challenges we face: intracerebral hemorrhage (ICH). With the launch of the Angels ICH Program, we are stepping into a new era of possibility — one built on evidence, teamwork, and the belief that even in the hardest conditions, improvement is always possible.
Over the years, acute ischemic stroke has taught us something powerful: if you measure the right things, change follows. Thrombolysis rates and door‑to‑needle times — these indicators didn’t just track performance; they revealed how strong and coordinated a stroke system really was.
In discussions with our expert advisory committee, we recognized a similar opportunity in ICH. Just as thrombolysis is the “litmus test” for ischemic stroke quality, blood pressure management may be the most telling marker for ICH. A single question — How quickly and consistently are teams bringing BP under control? — offers a remarkable window into the overall strength of the ICH pathway.
But of course, ICH quality is not defined by BP alone. The science is clear: improving outcomes requires implementing the full ICH care bundle, where each element reinforces the others.
That means:
- Early intensive blood pressure lowering
- Rapid reversal of abnormal anticoagulation
- Strict glucose management
- Temperature control
- Timely neurosurgical consultation and referral
These five elements are designed to work together — a coordinated bundle that delivers far more impact than any single action on its own. So, while BP will help us measure progress, our mission is to ensure that every hospital can implement the entire care bundle, reliably, rapidly, and for every patient, every time.
To understand what our baseline is, we asked Prof Robert Mikulík to analyse RES‑Q data from more than 16,000 ICH patients. The insights were revealing:
- 69% of ICH patients captured in RES-Q arrived with systolic BP > 140 mmHg.
- Of those with high BP, only 62% received IV antihypertensive treatment.
- Of the treated patients, 73% achieved a target BP ≤ 140 after treatment.
- Only 24% reached that target within one hour.
Their data also shows promising momentum: a median 33‑minute door‑to‑BP treatment time and around 70% of patients receiving BP‑lowering therapy within 60 minutes which is already in line with WSO certification standards.
This is exactly why the Angels will now apply the same strategy thatdelivered an astonishing 165 percent higher effect size than previously believed possible, in Fever, Sugar, Swallow (FESS) protocol implementation for post-acute stroke treatment. The strategy that I’m referring to the activatiion of all five Angels platforms — Consultancy, Standardization, Education, Community and Quality Monitoring. Together, they will help hospitals master the ICH bundle, build confidence, reduce delays, and embed new habits that save lives.
As part of this strategy, we will soon introduce ICH Quality Dashboards to support benchmarking and continuous improvement. And inspired by the success of the Ischemic Stroke Awards, we are preparing to launch the ICH Awards, shining a light on hospitals that deliver excellence in a field where excellence is deeply needed.
ICH has long been associated with devastation — sudden, severe, and often hopeless. But the landscape is shifting. INTERACT3 proved that timely, coordinated action changes outcomes. RES‑Q shows that progress is both possible and already underway. And our global community shows, every day, what happens when people believe that improvement is not just necessary — but achievable.
And now, as we stand at the start of this new chapter in ICH care, this is the moment for all of us — every neurologist, every emergency physician, every nurse, every stroke team — to act.
Because the evidence is no longer ambiguous. The ICH care bundle saves lives.
Not one part of it.
Not some of it.
All of it — implemented quickly, confidently, and in the right sequence.
So here is our call to action for all your ICH patients:
- Treat blood pressure aggressively and immediately. Don’t wait. Don’t hesitate. The target is clear, the timeline is tight, and every minute of delay costs the brain dearly.
- Reverse anticoagulation fast when it’s present — early reversal saves lives and prevents further bleeding.
- Control blood glucose and temperature with the same discipline we bring to BP management — because instability in either worsens outcomes.
- And just as thrombectomy taught us the power of structured, standardized referral systems, let’s bring that same mindset to neurosurgical escalation in ICH. Clear triggers, clear pathways, clear decision criteria, clear communication strategies. No ambiguity. No lost time. A coordinated response that turns potential hopelessness into a predictable, lifesaving sequence.
If we do this — if we implement the whole bundle, not partially, not eventually, but fully and immediately — we will give those patients who had little hope before, a second chance at life.
