Recommendations for implementing the INTERACT3 care bundle for intracerebral hemorrhage in Latin America: a Delphi Study

Background and aims The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3) showed that the implementation of a care bundle improves outcomes after acute intracerebral hemorrhage (ICH). We aimed to establish consensus-based recommendations for the broader integration of the care bundle across Latin American countries (LAC). Methods A 3-phase Delphi study allowed a panel of 32 healthcare workers from 14 LAC to sequentially rank various statements that commenced with 43 statements relevant to 7 domains (training, resources and infrastructure, education of patients, blood pressure, temperature, glycemic control, and reversal of anticoagulation). The pre-defined consensus threshold was 75%. Results A total of 55 statements reached consensus by the third round, which included 12 new statements that emerged through rounds. The highest-ranked statements in each domain emphasized critical aspects with successful implementation requiring a minimum level of resources to be made available. Key priorities included the continuous training of all healthcare workers involved in the management of ICH, establishing protocols aligned with available resources, and a collaborative inter-disciplinary approach to care being supported by institutional networks. Statements related to anticoagulation reversal were given the highest priority, which highlighted interest in the topic but limited availability of treatment in the region. Conclusions Consensus statements are provided to facilitate integration of the INTERACT3 care bundle to reduce disparities in ICH outcomes in LAC.