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Rapid Evacuation and Access of Cerebral Hemorrhage Trial
Sponsor: Emory University
Summary
The main purpose of this study is to compare patients with a deep bleed in the brain undergoing surgery to patients receiving routine medical care. The standard treatment involves admission to the Intensive Care Unit (ICU) with close monitoring and blood pressure control. It also includes other medical (non-surgical) treatments to prevent more bleeding or another stroke. Sometimes, doctors will recommend surgery to remove the blood if medical treatment alone is not successful. There is evidence that doing minimally invasive surgery early-using a small opening in the skull to remove blood-may help some patients. Researchers aim to understand whether this surgery is better than current medical treatment, which may include surgeries to relieve pressure on the brain in some cases. This study, called REACH, is comparing usual medical care to early minimally invasive surgery so doctors can know which is better for patients.
Key Details
Gender
All
Age Range
18 Years - 70 Years
Study Type
INTERVENTIONAL
Enrollment
600
Start Date
2025-05-27
Completion Date
2030-03
Last Updated
2026-03-19
Healthy Volunteers
No
Conditions
Interventions
Surgical management
Following randomization into the surgical arm, a competency-trained neurosurgeon will perform the MIPS for clot evacuation with strict adherence to the Surgical Manual of the CSG. Image interpretation, patient position, anesthetic plan, stereotactic navigation registration, exoscopic positioning, access, optics, resection, and hemostasis are detailed in the Surgical Manual of the CSG. The OR arrival time should occur \<24 hours from the last known normal (LKN) with a goal of arrival in less than 8 hours from the last known normal.
Medical Management
Following randomization into the medical arm patients will be treated following the Medical Manual of the CSG. The Medical Manual has been adapted by the REACH Executive Committee (REC) from the current American Heart Association (AHA) and American Stroke Association (ASA) Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Whenever clinically feasible, the CSG should be followed as it represents a template for the care of these subjects. The Medical Manual details specialty level of care, including intensive care placement, blood pressure control, hemostasis and coagulopathy, anemia, deep venous thrombosis and pulmonary embolism prophylaxis/treatment, glucose management, temperature management, seizure prophylaxis, intracranial pressure monitoring and management, intraventricular hemorrhage (IVH)/obstructive hydrocephalus management, cerebral edema, decompressive hemicraniectomy, nutritional support, respiratory support, and comfort care.
Locations (21)
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States
Stanford University Medical Center
Palo Alto, California, United States
Baptist Health Jacksonville FL
Jacksonville, Florida, United States
Baptist Health South Florida
Kendall, Florida, United States
Jackson Memorial Hospital (JMH)
Miami, Florida, United States
Grady Memorial Hospital
Atlanta, Georgia, United States
Emory Hospital Midtown
Atlanta, Georgia, United States
Emory University Hospital (EUH)
Atlanta, Georgia, United States
Rush University
Chicago, Illinois, United States
Endeavor Health, Northshore
Evanston, Illinois, United States
Goodman Campbell Brain and Spine
Carmel, Indiana, United States
University of Kentucky
Lexington, Kentucky, United States
Johns Hopkins School of Medicine
Baltimore, Maryland, United States
University of Missouri
Columbia, Missouri, United States
Albany Medical Center
Albany, New York, United States
SUNY Upstate Medical University
Syracuse, New York, United States
Montefiore Medical Center/Albert Einstein School of Medicine
The Bronx, New York, United States
The Ohio State University
Columbus, Ohio, United States
ProMedica Toledo Hospital
Toledo, Ohio, United States
Rhode Island Hospital/Brown University Health
Providence, Rhode Island, United States
Vanderbilt University Medical Center
Nashville, Tennessee, United States