Eelco F M Wijdicks

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (534)3102.48 Total impact

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    ABSTRACT: Given the rarity of brain death in clinical practice, trainees may complete their training without ever performing a brain death exam. Little is known about the performance of trainees in the evaluation of brain death. The accuracy of brain death determination can be audited and improved through simulation models. A simulated brain death scenario was designed to incorporate numerous potential confounders. We utilized a SimMan 3G mannequin, registered nurse, simulation technician, and a facilitator. Critical care and neurology trainees were evaluated using a 24-point checklist based on the AAN guidelines. Trainees rated their confidence (5 point scale with 1 = novice, 3 = competent, and 5 = fully confident) in the evaluation of brain death and apnea testing before and after completing the scenario. Following the simulation, trainees participated in debriefing sessions involving a review of the checklist and playback of simulation videos. Forty-one trainees completed the simulation. Trainees successfully completed 352/492 (71.5 %) tasks pertaining to the evaluation of prerequisites and 262/369 (71.0 %) tasks pertaining to the clinical examination. Trainee confidence in the evaluation of brain death (2.12 ± 0.74 vs 3.29 ± 0.62, p = 0.0001) and apnea testing (2.10 ± 0.74 vs 3.59 ± 0.77, p = 0.001) significantly improved. We successfully tested a new simulation model which emphasized training in crucial pitfalls. More than one in four trainees performed poorly in the evaluation of prerequisites and the clinical examination. Few trainees considered the possibility of drug or alcohol ingestion. Simulation training improved clinical performance and trainee confidence in the evaluation of brain death.
    Neurocritical Care 04/2015; DOI:10.1007/s12028-015-0130-0 · 2.60 Impact Factor
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    ABSTRACT: To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries. An electronic survey was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death. Most countries (n = 91, response rate 76%) reported a legal provision (n = 63, 70%) and an institutional protocol (n = 70, 77%) for brain death. Institutional protocols were less common in lower-income countries (2/9 of low [22%], 9/18 lower-middle [50%], 22/26 upper-middle [85%], and 37/38 high-income countries [97%], p < 0.001). Countries with an organized transplant network were more likely to have a brain death provision compared with countries without one (53/64 [83%] vs 6/25 [24%], p < 0.001). Among institutions with a formalized brain death protocol, marked variability occurred in requisite examination findings (n = 37, 53% of respondents deviated from the American Academy of Neurology criteria), apnea testing, necessity and type of ancillary testing (most commonly required test: EEG [n = 37, 53%]), time to declaration, number and qualifications of physicians present, and criteria in children (distinct pediatric criteria: n = 38, 56%). Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable. © 2015 American Academy of Neurology.
    Neurology 04/2015; DOI:10.1212/WNL.0000000000001540 · 8.30 Impact Factor
  • The Lancet 04/2015; 385(9974). DOI:10.1016/S0140-6736(15)60631-6 · 39.21 Impact Factor
  • Eelco F M Wijdicks
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    ABSTRACT: Brain death is diagnosed in the minority of patients with acute severe brain injury. Guidelines have been developed in many countries in the world and physicians usually work through a set of criteria. The clinical evaluation starts with determination of futility of any medical or surgical intervention and an unmistakable certainty that the underlying diagnosis is correct. The actual neurologic evaluation in a patient suspected of being brain dead requires 25 tests and verifications. Brain death determination demands perfect diagnostic accuracy and thus requires skill and expertise. The overriding principle is simple: establish cause, exclude confounders, determine futility of interventions, examine brainstem reflexes, and test for apnea. In this review, the author revisits the American Academy of Neurology guidelines, and examines the details behind the guidelines. The 2010 guidelines have eliminated unnecessary tests and observation delays, and maintain a principle of simplicity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    Seminars in Neurology 04/2015; 35(2):105-115. DOI:10.1055/s-0035-1547532 · 1.78 Impact Factor
  • Sara Hocker, Eelco F M Wijdicks
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    ABSTRACT: Skill in the determination of brain death is traditionally acquired during training in an apprenticeship model. Brain death is not frequently determined, and thus exposure to the techniques used is marginal. Brain death is therefore ideally suited for competency-based education models such as simulation. Simulation can ensure that all trainees have direct experience in brain death determination irrespective of their specialty, program design, or institutional protocol. In this review, the authors discuss the advantages and barriers to simulation and how to develop simulation scenarios for instruction in the determination of brain death. Future research should focus on validation of brain death simulation methods and assessment tools as well as the impact of simulation on performance in clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    Seminars in Neurology 04/2015; 35(2):180-188. DOI:10.1055/s-0035-1547535 · 1.78 Impact Factor
  • Eelco F M Wijdicks
    Seminars in Neurology 04/2015; 35(2):103-104. DOI:10.1055/s-0035-1547531 · 1.78 Impact Factor
  • Eelco F M Wijdicks
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2015; 28(1):41. DOI:10.1097/WNN.0000000000000052 · 1.14 Impact Factor
  • Neurology 02/2015; 84(8):e57-8. DOI:10.1212/WNL.0000000000001296 · 8.30 Impact Factor
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    ABSTRACT: A 26-year-old female with myasthenic crisis developed transfusion-related acute lung injury (TRALI) after she was treated with intravenous immunoglobulin. Case report. Respiratory status markedly worsened with each intravenous immunoglobulin (IVIG) administration and progressing from a need to use bilevel positive airway pressure (BiPAP) to intubation. Pulmonary function tests improved during this episode. IVIG may cause TRALI and due to subtle clinical findings can be mistaken for neuromuscular respiratory failure.
    Neurocritical Care 02/2015; DOI:10.1007/s12028-015-0115-z · 2.60 Impact Factor
  • Eelco F M Wijdicks
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    ABSTRACT: This editorial is not a homily on responsibility, but it is imperative for the Neurocritical Care Society membership to publish in Neurocritical Care in order to continue its growth. The unpleasant fact is that many more should contribute to this task. The journal should be the main repository of original articles and review papers that interest us all. Simply put, it should not be a painstaking process to decide where to submit your paper. Its proximity is an opportunity—not an option.Why is this suddenly an urgent matter? First and foremost, there has been an explosion of open-access journals and new advances in digital technology will continue to challenge the whole concept of a journal, its structure, and whether it is the best platform. Open-access journals entice authors with a barrage of emails and often with a hidden fee or other unexpected later discomfort in return of the promise to publish quickly. One can understand that it is human nature to circumnavigate a sometimes frus ...
    Neurocritical Care 12/2014; 22(1). DOI:10.1007/s12028-014-0099-0 · 2.60 Impact Factor
  • Eelco F M Wijdicks, David K Menon, Martin Smith
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    ABSTRACT: Care of the critically ill neurologic patient, more commonly referred to as neurocritical care, has matured through new knowledge [1], policy and administration [2-4], advances in imaging and monitoring techniques, and above all the introduction of neurointensivists and neuroscience intensive care units [5, 6]. Different models of care exist but, whether provided in a specialist unit or within a general intensive care unit (ICU), the principles and standards of neurocritical care are identical. All three of us work in neurocritical care units and provide care for the most challenging patients on the edge of further deterioration. Our expertise is based on each of us having over 1,000 patient contacts annually for the past 1-2 decades. Here we share what we believe is important—and what worries us.1. Create a core groupA well-run neurocritical care program should have several neurointensivists. Neurocritical care demands 24/7 staffing from teams with experience in managing neurological ...
    Intensive Care Medicine 11/2014; 41(2). DOI:10.1007/s00134-014-3544-9 · 5.54 Impact Factor
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    ABSTRACT: Impaired consciousness has been incorporated in prediction models that are used in the ICU. The Glasgow Coma Scale has value but is incomplete and cannot be assessed in intubated patients accurately. The Full Outline of UnResponsiveness score may be a better predictor of mortality in critically ill patients.
    Critical Care Medicine 11/2014; DOI:10.1097/CCM.0000000000000707 · 6.15 Impact Factor
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    ABSTRACT: Abstract Neurological complications are common in general medical and surgical intensive care units (ICU); they can prolong ICU and hospital stay and worsen outcome, including mortality. We performed a descriptive analysis of neurological consultations in non-neurological ICUs to determine the frequency of various neurological complications and to assess the diagnostic yield, therapeutic implications and prognostic benefit of these consultations. This is a retrospective single group cohort study of all neurological consultations for patients admitted to non-neurological (medical, respiratory care unit, cardiac, cardiothoracic, surgical, and trauma) ICUs at Saint Marys Hospital (Mayo Clinic, Rochester) over a 24- month period (January 1st 2010 to December 31st 2011). Equal numbers of neurological consultations (174, 50% each) were requested from medical ICUs and surgical ICUs. Altered consciousness (158, 45%), seizure (76, 22%), and focal deficits (75, 22%) were the most common reasons for consultations. Diagnostic, prognostic, and therapeutic benefit was considered present in 89%, 38%, and 39% patients respectively. Treatment change following neurological consultation occurred in 48% patients. Encephalopathy, stroke, seizure, and anoxic brain injury were the most common causes of neurological complications in non-neurological ICUs with sedatives and opiates being the most common cause of encephalopathy. Almost half of the patients had change in treatment following neurological consultation. Neurological consultations in non-neurological ICU's are beneficial for patient's care in terms of diagnosis, treatment, and prognosis.
    International Journal of Neuroscience 09/2014; DOI:10.3109/00207454.2014.950374 · 1.53 Impact Factor
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    ABSTRACT: IMPORTANCE Research to improve outcomes from acute central nervous system (CNS) injury has progressed little, although limited examples (eg, induced hypothermia for out-of-hospital ventricular fibrillation cardiac arrest and birth asphyxia and tissue plasminogen activator for ischemic stroke) have proved that it is possible to favorably alter outcome. OBJECTIVE To chronicle the evolution of preclinical research designed to provide therapeutic interventions for acute CNS injury. EVIDENCE REVIEW Preclinical literature cited by major clinical intervention trials was systematically assessed with respect to fulfillment of fundamental elements of experimental design in current guidelines. FINDINGS Preclinical studies of acute CNS injury to date have a poor record of adhering to basic tenets of experimental design, including randomization, concealment of treatment allocation, definition of sustained robustness of therapeutic benefit, and emulation of clinical disease. Major clinical trials continue to be justified and conducted on the basis of weak preclinical evidence. Publication of preclinical research guidelines and endorsement by scientific journals have been insufficient to alter practice. Novel approaches to preclinical therapeutic development, including multicenter phase 3 trials and preclinical trial registries that document a priori experimental design and primary dependent variables, may overcome this intransigence and enhance possibility for therapeutic breakthroughs. CONCLUSIONS AND RELEVANCE Current knowledge of acute CNS injury dictates that therapeutic discovery and translation apply known tenets of sound experimental design and emulation of the clinical disorder targeted for therapeutic intervention. Peer-review systems must demand these qualities in proposed and published research to assess validity and potential for clinical translation.
    JAMA Neurology 08/2014; 71(10). DOI:10.1001/jamaneurol.2014.1238 · 7.01 Impact Factor
  • Sumedh S Hoskote, Jennifer E Fugate, Eelco F M Wijdicks
    Journal of Cardiothoracic and Vascular Anesthesia 08/2014; 28(4):1039-1041. DOI:10.1053/j.jvca.2013.12.019 · 1.48 Impact Factor
  • Christopher L Kramer, Eelco F M Wijdicks
    Neurology 07/2014; 83(4):376. DOI:10.1212/WNL.0000000000000624 · 8.30 Impact Factor
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    ABSTRACT: Electroencephalography in the setting of hypothermia and anoxia has been studied in humans since the 1950s. Specific patterns after cardiac arrest have been associated with prognosis since the 1960s, with several prognostic rating scales developed in the second half of the twentieth century. In 2002, two pivotal clinical trials were published, demonstrating improved neurologic outcomes in patients treated with therapeutic hypothermia (TH) after cardiac arrest of shockable rhythms. In the following years, TH became the standard of care in these patients. During the same time period, the use of continuous EEG monitoring in critically ill patients increased, which led to the recognition of subclinical seizures occurring in patients after cardiac arrest. As a result of these changes, greater amounts of EEG data are being collected, and the significance of specific patterns is being re-explored. We review the current role of EEG for the identification of seizures and the estimation of prognosis after cardiac resuscitation.
    Neurocritical Care 07/2014; 22(1). DOI:10.1007/s12028-014-0018-4 · 2.60 Impact Factor
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    ABSTRACT: Introduction Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG. Methods A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc. Results Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p <0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p = 0.088). There was no difference in mortality or clinical outcome in these cohorts. Conclusions Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.
    Resuscitation 06/2014; 85(6). DOI:10.1016/j.resuscitation.2014.01.019 · 3.96 Impact Factor
  • Sara E Hocker, Eelco F M Wijdicks
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    ABSTRACT: This article reviews the current understanding of sepsis, a critical and often fatal illness that results from infection and multiorgan failure and impacts the brain, peripheral nervous system, and muscle.
    CONTINUUM Lifelong Learning in Neurology 06/2014; 20(3, Neurology of Systemic Disease):598-613. DOI:10.1212/01.CON.0000450968.53581.ff

Publication Stats

12k Citations
3,102.48 Total Impact Points

Institutions

  • 1995–2015
    • Mayo Clinic - Rochester
      • • Department of Pulmonary and Critical Care Medicine
      • • Department of Neurology
      • • Department of Neurosurgery
      Рочестер, Minnesota, United States
  • 2001–2014
    • Mayo Foundation for Medical Education and Research
      • Department of Neurology
      Рочестер, Michigan, United States
  • 2013
    • University of California, Los Angeles
      • Department of Neurology
      Los Ángeles, California, United States
    • Vanderbilt University
      • Department of Neurology
      Нашвилл, Michigan, United States
  • 2011
    • National University of Singapore
      • Division of Neurology
      Singapore, Singapore
  • 2010
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
  • 2008
    • The University of Western Ontario
      London, Ontario, Canada
    • Rush University Medical Center
      • Department of Neurological Sciences
      Chicago, IL, United States
    • Atrium Medisch Centrum Parkstad
      Heerlen, Limburg, Netherlands
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
  • 1994–2008
    • St. Marys Medical Center
      West Palm Beach, Florida, United States
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 2006
    • Washington University in St. Louis
      San Luis, Missouri, United States
    • Lourdes Hospital
      Edakkulam, Kerala, India
    • The University of Calgary
      Calgary, Alberta, Canada
  • 2005
    • University of Miami Miller School of Medicine
      • Department of Neurology
      Miami, FL, United States
  • 1995–2004
    • St. Mary Medical Center
      Long Beach, California, United States
  • 2002
    • University of Groningen
      Groningen, Groningen, Netherlands
    • Central Military Hospital
      Utrecht, Utrecht, Netherlands
  • 2000
    • Los Angeles Neurosurgical Institute
      Los Angeles, California, United States
  • 1988–1995
    • Universiteit Utrecht
      • Department of Neurology
      Utrecht, Provincie Utrecht, Netherlands
    • Erasmus Universiteit Rotterdam
      • Department of Neurology
      Rotterdam, South Holland, Netherlands
  • 1989–1992
    • University Medical Center Utrecht
      • Department of Neurology
      Utrecht, Provincie Utrecht, Netherlands