Eelco F M Wijdicks

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (595)3433.31 Total impact

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    ABSTRACT: Purpose: The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure. Methods: We review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria. Results: Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques. Conclusions: Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.
    No preview · Article · Jan 2016 · Intensive Care Medicine
  • Eelco F M Wijdicks

    No preview · Article · Jan 2016 · Neurocritical Care
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    ABSTRACT: Importance Brain death is the irreversible cessation of function of the entire brain, and it is a medically and legally accepted mechanism of death in the United States and worldwide. Significant variability may exist in individual institutional policies regarding the determination of brain death. It is imperative that brain death be diagnosed accurately in every patient. The American Academy of Neurology (AAN) issued new guidelines in 2010 on the determination of brain death.Objective To evaluate if institutions have adopted the new AAN guidelines on the determination of brain death, leading to policy changes.Design, Setting, and Participants Fifty-two organ procurement organizations provided US hospital policies pertaining to the criteria for determining brain death. Organizations were instructed to procure protocols specific to brain death (ie, not cardiac death or organ donation procedures). Data analysis was conducted from June 26, 2012, to July 1, 2015.Main Outcomes and Measures Policies were evaluated for summary statistics across the following 5 categories of data: who is qualified to perform the determination of brain death, what are the necessary prerequisites for testing, details of the clinical examination, details of apnea testing, and details of ancillary testing. We compared these data with the standards in the 2010 AAN update on practice parameters for brain death.Results A total of 508 unique hospital policies were obtained, representing the majority of hospitals in the United States that would be eligible and equipped to evaluate brain death in a patient. Of these, 492 provided adequate data for analysis. Although improvement with AAN practice parameters was readily apparent, there remained significant variability across all 5 categories of data, such as excluding the absence of hypotension (276 of 491 policies [56.2%]) and hypothermia (181 of 228 policies [79.4%]), specifying all aspects of the clinical examination and apnea testing, and specifying appropriate ancillary tests and how they were to be performed. Of the 492 policies, 163 (33.1%) required specific expertise in neurology or neurosurgery for the health care professional who determines brain death, and 212 (43.1%) stipulated that an attending physician determine brain death; 150 policies did not mention who could perform such determination.Conclusions and Relevance Hospital policies in the United States for the determination of brain death are still widely variable and not fully congruent with contemporary practice parameters. Hospitals should be encouraged to implement the 2010 AAN guidelines to ensure 100% accurate and appropriate determination of brain death.
    No preview · Article · Dec 2015
  • Eelco F. M. Wijdicks

    No preview · Article · Dec 2015 · Neurocritical Care
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    ABSTRACT: This study aims to explore the clinical features, radiological findings, management and the factors influencing prognosis in PCR-confirmed herpes simplex virus encephalitis (HSE). This is a retrospective review of consecutive patients diagnosed with HSE at Mayo Clinic, Rochester, MN, between January 1995 and December 2013. Only HSE cases confirmed by PCR were included. Univariate and multivariate analysis was used to identify factors associated with good (modified Rankin Scale of 0-2) or poor outcome (mRS of 3-6) at hospital discharge and 1-year follow-up. We identified 45 patients with HSE. Median age was 66 (IQR 53.5-78) years. HSE was caused by HSV-1 in 33 cases and by HSV-2 in 9. Nearly half had seizures upon admission or during hospitalization. The most common regions involved on MRI were the temporal lobe in 35 (87.5 %), insula in 28 (70.0 %), frontal lobe in 27 (67.5 %) and thalamus in 11 (27.5 %) patients. MRI pattern was quite homogeneous with HSV-1 infection, but much more heterogeneous with HSV-2. Good outcome at discharge and at 6-12 months was seen in 16 (35.6 %) and 27 (65.9 %) patients, respectively. On multivariate analyses, older age (p = 0.001), coma (p = 0.008), restricted diffusion on MRI (p = 0.005) and acyclovir started after the first day of admission (p = 0.050) were associated with poor outcome at discharge. Older age, development of coma, presence of restricted diffusion on brain MRI and delay in the administration of acyclovir portend poor outcome in HSE. Conversely, presence of seizures, focal neurological deficits, EEG abnormalities and location or extension of FLAIR/T2 abnormalities did not influence functional outcome.
    No preview · Article · Nov 2015 · Journal of Neurology
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    Eelco F. M. Wijdicks · Andrew A. Kramer · Thomas Rohs

    Full-text · Article · Oct 2015 · Critical Care Medicine
  • Eelco F M Wijdicks
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    ABSTRACT: Purpose of review: Major complexities exist in the assessment of a patient with a catastrophic neurologic disorder that might have progressed to loss of all brain function. The determination of brain death and initial management of the potential organ donor is one of the major key tasks of the neurologist. This article addresses the potential for errors, mimickers, and uncertainties associated with ancillary tests for determining brain death. Recent findings: Major professional neurologic organizations including the American Academy of Neurology have published guidelines for the determination of brain death in both adults and children. Checklists are now available to assist physicians in the assessment of the patient. Summary: The clinical diagnosis of brain death in a patient with a catastrophic brain injury is determined by a comprehensive clinical examination that involves at least 25 individual assessments. It requires excluding confounding factors first (to confirm futility), examining the patient carefully with special attention to signs of brainstem function, and, finally, performing an apnea test. Once a patient is declared brain dead, organ donation may proceed after consent is obtained.
    No preview · Article · Oct 2015
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    Matthijs C Brouwer · Eelco F M Wijdicks · Diederik van de Beek

    Full-text · Article · Oct 2015 · Intensive Care Medicine
  • Eelco F M Wijdicks

    No preview · Article · Sep 2015
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    ABSTRACT: To report the clinical and laboratory characteristics, clinical courses, and outcomes of Mayo Clinic, Rochester, MN, ICU-managed autoimmune encephalitis patients (January 1st 2003-December 31st 2012). Based on medical record review, twenty-five patients were assigned to Group 1 (had ≥1 of classic autoimmune encephalitis-specific IgGs, n = 13) or Group 2 (had ≥3 other characteristics supporting autoimmunity, n = 12). Median admission age was 47 years (range 22-88); 17 were women. Initial symptoms included ≥1 of subacute confusion or cognitive decline, 13; seizures, 12; craniocervical pain, 5; and personality change, 4. Thirteen Group 1 patients were seropositive for ≥1 of VGKC-complex-IgG (6; including Lgi1-IgG in 2), NMDA-R-IgG (4), AMPA-R-IgG (1), ANNA-1 (1), Ma1/Ma2 antibody (1), and PCA-1 (1). Twelve Group 2 patients had ≥3 other findings supportive of an autoimmune diagnosis (median 4; range 3-5): ≥1 other antibody type detected, 9; an inflammatory CSF, 8; ≥1 coexisting autoimmune disease, 7; an immunotherapy response, 7; limbic encephalitic MRI changes, 5; a paraneoplastic cause, 4; and diagnostic neuropathological findings, 2. Among 11 patients ICU-managed for ≥4 days, neurological improvements were attributable to corticosteroids (5/7 treated), plasmapheresis (3/7), or rituximab (1/3). At last follow-up, 10 patients had died. Of the remaining 15 patients, 6 (24 %) had mild or no disability, 3 (12 %) had moderate cognitive problems, and 6 (24 %) had dementia (1 was bed bound). Median modified Rankin score at last follow-up was 3 (range 0-6). Good outcomes may occur in ICU-managed autoimmune encephalitis patients. Clinical and testing characteristics are diverse. Comprehensive diagnostics should be pursued to facilitate timely treatment.
    No preview · Article · Aug 2015 · Neurocritical Care
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    ABSTRACT: Strict maintenance of normovolemia is standard of care in the treatment of aneurysmal subarachnoid hemorrhage (aSAH), and induced hypervolemia is often used to treat delayed cerebral ischemia from vasospasm. We tested the hypothesis that positive fluid balance could adversely affect clinical outcomes in aSAH. We reviewed 288 patients with aSAH admitted to the Neuroscience Intensive Care Unit (NICU) from October 2001 to June 2011. We collected data on fluid balance during NICU stay, clinical and radiographic evidence of vasospasm, cardiopulmonary complications, and functional outcomes by modified Rankin Scale (mRS) on follow-up (mean 8 ± 8 months). Poor functional outcome was defined as an mRS score 3-6. Associations of variables of interest with outcome were assessed using univariable and multivariable logistic regression. Propensity scores were estimated to account for imbalances between patients with positive versus negative fluid balance and were included in multivariable models. Average net fluid balance during the NICU stay was greater in patients with poor functional outcome (3.52 ± 5.51 L versus -.02 ± 5.30 L in patients with good outcome; P < .001). On multivariate analysis, positive fluid balance (P = .002) was independently associated with poor functional outcome along with World Federation of Neurosurgical Societies grade (P < .001), transfusion (P = .003), maximum glucose (P = .005), and radiological evidence of cerebral infarction (P = .008). After regression adjustment with propensity scores, the association of positive fluid balance with poor functional outcome remained significant (odds ratio, 1.18; 95% confidence interval, 1.08-1.29; P < .001). Greater positive net fluid balance is independently associated with poorer functional outcome in patients with aSAH. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Aug 2015 · Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association
  • Sara Hocker · Steven K Feske · Eelco F M Wijdicks · Frank W Drislane

    No preview · Article · Jul 2015 · Annals of Neurology
  • Sara Hocker · Eelco F M Wijdicks

    No preview · Article · Jul 2015
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    ABSTRACT: Focal ventricular obstruction-trapped ventricle-results in cerebrospinal fluid accumulation, mass effect and possible clinical deterioration. There are no systematic studies on the benefit of surgical decompression in adults. We reviewed patients admitted with acutely trapped ventricle on brain imaging to assess their prognosis and the effect of surgical intervention on 30-day mortality. Of the 392 patients with trapped ventricle, the most common causes were brain tumor (45 %), intracerebral hemorrhage (ICH) (20 %), and subdural hematoma (SDH) (14 %). Lateral ventricle trapping accounted for 97 % of cases. Two hundred and twenty-one patients (56 %) received a surgical intervention for trapped ventricle or its causes; 126 (83 %) were treated with craniotomy, 26 (17 %) with craniectomy, 30 (14 %) with external ventricular drain (EVD) alone, 23 (10 %) with ventriculoperitoneal shunt alone, and 16 (7 %) with endoscopic fenestration of the septum pellucidum. Surgical intervention was associated with mortality reduction from 95 % (n = 54) to 48 % (n = 11) in the ICH group, from 47 % (n = 27) to 12 % (n = 15) in the tumor group and from 90 % (n = 18) to 20 % (n = 7) in the SDH group (p < 0.001 for all comparisons). Univariate logistic analysis showed that surgical intervention and tumor etiology were associated with decreased mortality while age, ICH etiology, intraventricular hemorrhage, midline shift, and anticoagulation were associated with increased mortality. On multivariate logistic regression, surgical intervention remained associated with decreased mortality (p < 0.0001; OR 0.20, 95 % CI 0.09-0.42). On subgroup analysis of the ICH cohort, surgical intervention was also associated with decreased mortality (p = 0.028). Neurosurgical intervention for decompression in patients with trapped ventricle can have a measurable beneficial effect on early mortality.
    No preview · Article · May 2015 · Neurocritical Care
  • Sara Hocker · Donna Schumacher · Jay Mandrekar · Eelco F M Wijdicks
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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.
    No preview · Article · Apr 2015 · Neurocritical Care
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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.
    No preview · Article · Apr 2015 · Neurology
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    Full-text · Article · Apr 2015 · The Lancet
  • 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.
    No preview · Article · Apr 2015 · Seminars in Neurology
  • Eelco F M Wijdicks

    No preview · Article · Apr 2015 · Seminars in Neurology
  • Jennifer E Fugate · Alejandro A Rabinstein · Eelco F M Wijdicks

    No preview · Article · Apr 2015 · Critical Care Medicine

Publication Stats

18k Citations
3,433.31 Total Impact Points

Institutions

  • 1994-2015
    • Mayo Clinic - Rochester
      • • Department of Pulmonary and Critical Care Medicine
      • • Department of Neurology
      Рочестер, Minnesota, United States
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 2001-2014
    • Mayo Foundation for Medical Education and Research
      • Department of Neurology
      Рочестер, Michigan, United States
  • 2010
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
  • 2008
    • Atrium Medisch Centrum Parkstad
      Heerlen, Limburg, Netherlands
    • Rush University Medical Center
      • Department of Neurological Sciences
      Chicago, IL, United States
  • 2006
    • The University of Calgary
      Calgary, Alberta, Canada
    • Washington University in St. Louis
      San Luis, Missouri, United States
  • 2005
    • University of Miami Miller School of Medicine
      • Department of Neurology
      Miami, Florida, United States
  • 1997-2005
    • St. Marys Medical Center
      West Palm Beach, Florida, United States
  • 1998-2004
    • St. Mary's Hospital (WI, USA)
      Madison, Wisconsin, United States
  • 1999-2003
    • St. Mary Medical Center
      Long Beach, California, United States
  • 2002
    • University of Groningen
      Groningen, Groningen, Netherlands
    • Central Military Hospital
      Utrecht, Utrecht, Netherlands
  • 1995
    • St. Mary’s Hospital for Children
      New York, New York, United States
  • 1988-1995
    • Utrecht University
      • Department of Neurology
      Utrecht, Utrecht, Netherlands
  • 1991-1992
    • University Medical Center Utrecht
      • Department of Neurology
      Utrecht, Provincie Utrecht, Netherlands