Background and aims: Recently, the INTERACT3 care bundle results showed improved clinical outcomes for patients with intracerebral hemorrhage (ICH), however its implementation in Latin American countries (LAC) faces unique challenges. We aimed to establish recommendations for the integration of the INTERACT3 care bundle across LAC.
Methods: A Three-phase Delphi study was performed among 32 healthcare workers from 14 LAC. A comprehensive review of the INTERACT3 process evaluation generated the first statements across 7 domains: training, resources and infrastructure, education to patients, blood pressure, temperature, glycemic control, and reversal of anticoagulation. Panelists rated statements in each round, with the final round allowing for ranking. Consensus threshold was predefined at 75%.
Results: All 43 statements reached consensus by the conclusion of the third round, an additional 12 new statements emerged throughout the rounds. The highest-ranked statements in each domain emphasized critical aspects, placing particular emphasis on ensuring minimal resources for successful implementation. Key priorities included continuous training for all healthcare workers involved in managing ICH patients, the establishment of protocols aligned with available resources, and fostering a collaborative approach through the creation of communication channels between professionals and healthcare institutions support networks. Notably, statements related to anticoagulation reversal were the highest ranked among all statements highlighting the limited availability of treatments and the overall lack of knowledge regarding anticoagulation reversal in the region.
Conclusions: The findings of the study provide key aspects to address integration of the INTERACT3 care bundle in LAC, in effort to mitigate the disparities in ICH outcomes.