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. ### Competing Interest Statement CSA reports research grants from the National Health and Medical Research Council (NHMRC) of Australia, the Medical Research Council (MRC) and Medical Research Foundation (MRF) of the UK, and Takeda and Penumbra. PMV receives research grants from ANID Fondecyt Regular 1221837, Pfizer and Boehringer Ingelheim. BC gets research grants from Fondecyt Regular 1201461. AO receives research grants from Merck. VCN report research grant from AstraZeneca and is a speaker for Boehringer and Sanofi. The other authors declare no conflict of interest. ### Funding Statement This study was funded by The George Institute of Global Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Scientific Ethics Committee of Clínica Alemana-Universidad del Desarrollo (number 2023-68). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author,PMV, upon reasonable request.