Overview & Scope
🏥 What Is the Neuro Hub?
The Regional Neuro Hub is the primary triage and consultation point for all Intracerebral Hemorrhage (ICH) cases at this facility and affiliated sites — excluding LAMC, which has its own neurosurgical coverage.
The Hub is staffed by Regional Vascular Neurology and exists to:
The Hub is staffed by Regional Vascular Neurology and exists to:
- → Standardize acute ICH management across the network
- → Optimize ICU capacity utilization
- → Reduce unnecessary or premature neurosurgical transfers
- → Provide real-time guidance on BP targets, reversal agents, and osmotherapy
⚠️ Site Exclusion: LAMC patients are excluded from this protocol. All other ED and Hospitalist sites route ICH through this Hub before any neurosurgical contact.
Access — Hours & Contact
📞 Primary Contact — ETAP Line
866-361-2911
Available during all operational hours · ~5 min callback guaranteed
🕐 Standard Operational Hours
1:00 PM – 9:00 PM
7 Days/Week · Including Weekends & Holidays
The Neurology First Rule
🚫
Do NOT Page Neurosurgery Directly for ICH
All ICH cases — regardless of size, location, or perceived severity — must be triaged through the Regional Vascular Neurology team via the ETAP line first.
The Neuro Hub neurologist will determine whether surgical escalation is warranted and will initiate neurosurgery contact internally if needed. Bypassing this step delays standardized care, disrupts triage flow, and may result in inappropriate or premature surgical referrals.
One call. One number. Every time: 866-361-2911
The Neuro Hub neurologist will determine whether surgical escalation is warranted and will initiate neurosurgery contact internally if needed. Bypassing this step delays standardized care, disrupts triage flow, and may result in inappropriate or premature surgical referrals.
One call. One number. Every time: 866-361-2911
When to Call — Clinical Triggers
🔴 Mandatory Call Triggers
- Any confirmed ICH on CT head or MRI — regardless of volume, location, or GCS
- Any suspected ICH with high clinical probability pending imaging
- ICH with concurrent anticoagulation — Warfarin, DOAC, antiplatelet — requiring urgent reversal guidance
- ICH with acute BP crisis requiring titration target guidance
- ICH with neurological deterioration — GCS decline, new herniation signs
⚡ 5-Minute Callback — Immediate Consult Topics
⏱ ~5 min callback guaranteed
- Blood pressure titration targets — individualized SBP goal (typically <140–160 mmHg depending on presentation)
- Anticoagulation reversal — Kcentra (4F-PCC) for warfarin/Xa inhibitors, Andexxa for direct Xa inhibitors, idarucizumab for dabigatran
- Hyperosmotic therapy — Mannitol vs. hypertonic saline, dosing, ICP monitoring guidance
- Seizure prophylaxis, glucose management, fever control, VTE prophylaxis timing
Anticoagulation Reversal — Quick Reference
💊 Reversal Agents (Neuro Hub will confirm dosing for individual patient)
| Anticoagulant | Agent | Reversal Drug | Starting Point |
|---|---|---|---|
| Warfarin (supratherapeutic INR) | 4F-PCC (Kcentra) | Kcentra | 25–50 units/kg IV (INR-based dosing) + Vitamin K 10mg IV |
| Direct Xa inhibitor (rivaroxaban, apixaban, edoxaban) | Andexanet alfa | Andexxa | Low or High dose regimen based on drug & last dose timing — Neuro Hub directs |
| Direct Xa inhibitor (if Andexxa unavailable) | 4F-PCC off-label | Kcentra | 50 units/kg IV — per Neuro Hub guidance |
| Dabigatran (direct thrombin inhibitor) | Idarucizumab | Praxbind | 5g IV (two 2.5g vials) — reversal within minutes |
| Heparin / LMWH | Protamine sulfate | Protamine | 1mg per 100 units heparin (last 2–4h); 1mg per 1mg enoxaparin |
⚠️ All reversal dosing should be confirmed with the Neuro Hub neurologist on the ETAP line before administration. Anti-Xa levels may be required prior to Andexxa administration.
Quick Reference Triage Flowchart
1
CT Head confirms or strongly suspects ICH
Patient presents with focal neurological deficit, headache, altered mental status, or acute hypertension. Non-contrast CT head obtained.
→ Do not delay this step to call anyone.
→ Do not delay this step to call anyone.
↓
2
Immediate stabilization while calling
Airway: Assess — intubate if GCS ≤8 or airway at risk |
BP: Begin antihypertensives (nicardipine, labetalol) targeting SBP <180 while awaiting Hub guidance |
Glucose: Check and correct |
Anticoagulation: Determine agent and last dose — do not reverse until Hub confirms
↓
3
Call ETAP Line — 866-361-2911
Available 1:00 PM – 9:00 PM daily (currently expanded to 7:00 AM – 9:00 PM).
Expect callback within ~5 minutes. Have ready: CT findings, GCS, vitals, medications/anticoagulants, INR/anti-Xa level if available.
↓
4
Neuro Hub Neurologist Triages Case
Hub neurologist reviews case and directs: BP target, reversal protocol, osmotherapy, disposition.
They will contact Neurosurgery internally if surgical evaluation is warranted — you do not need to call Neurosurgery.
↓
Does the patient require surgical intervention?
↓
✅ Medical Management Only
No neurosurgery consult required from your end.Neuro Hub directs ongoing care:
· BP titration to target
· Anticoagulation reversal completed
· Osmotherapy as needed
· ICU admission per Hub guidance
· Repeat imaging protocol
🔵 Surgical Escalation Needed
Neuro Hub neurologist contacts Neurosurgery directly and internally.You will be notified of the surgical plan.
· Transfer vs. in-house OR determined by Hub
· You continue medical stabilization
· Hub coordinates logistics and transport if needed
Disposition Summary
✅ Medical ICH — No Surgery
Managed at your facility per Neuro Hub protocol. No neurosurgery consult needed from your end. Neuro Hub oversees care plan and follow-up imaging timing.
🔵 Surgical Escalation
Neuro Hub neurologist handles neurosurgery contact. Transfer arranged by Hub if operative intervention requires a higher-level facility.
⚠️ Outside Hub Hours
Outside operational hours (before 1 PM standard / before 7 AM expanded), contact your on-call neurologist or transfer center per your facility's backup protocol.
One-Page Rapid Reference
⚡ Neuro Hub ICH — At a Glance
Who to Call
866-361-2911
ETAP Line · Vascular Neurology · ~5 min callback
When Open
Standard: 1 PM – 9 PM daily
Expanded: 7 AM – 9 PM (current)
Hub Covers
BP targets · Kcentra / Andexxa / Praxbind dosing · Osmotherapy · Neurosurgery escalation · ICU disposition
Do NOT
Page Neurosurgery directly · Reverse anticoagulation without Hub guidance · Skip the call for "small" ICH