Brain; Coma; Heart Arrest; Hypothermia, Induced; Nervous System Diseases; Neurology; Neurosurgery; Stroke; Neuroimaging
My research focuses on improving the ability for doctors to give an accurate prognosis for patients in coma, particularly after suffering a cardiac arrest. I am also interested in the use of hypothermia to improve neurological outcomes for various brain injuries. Ongoing projects include the appropriate training of clinicians to pronounce brain death, and differences between subspecialties who do so; a study of the use of clot-dissolving medications for patients with bleeding in the drainage system of the brain, and study looking at the use of induced hypothermia (cooling) for treating patients with large strokes.
Specialized Terms: Coma; Neurocritical care; Stroke; Neuroimaging
Extensive Research Description
My research to this point has focused on the arenas of stroke and neurocritical care. I have had a strong interest in stroke prevention studies, such as the multi-national antiplatelet trial, PROFESS. I have taken part in multiple trials comparing carotid stenting and endarterectomy. I have also studied neuroimaging features of both ischemic and hemorrhagic stroke for prediction of outcome.
My neurocritical care studies in the past have included coma, brain death, hypothermia and extubation. I have a stroke interest in features that may predict outcome from coma and cardiac arrest, including neuroimaging, electrophysiology, biomarkers and the clinical examination. I have studied the variability in brain death determination, with a goal of providing standardization in this field. I have also studied the use of hypothermia in cardiac arrest and stroke, showing the safety of combined hypothermia and cardiac catheterization. I also studied a large neurocritical care population for predictors of failure or success after attempted extubation.
My ongoing studies at Yale include a study to look at how physicians are trained to perform brain death determination, including variability between different specialties. I am the principle investigator for the CLEAR III trial, evaluating the safety and efficacy of intraventricular TPA for patients with intraventricular hemorrhage. I am the principle investigator for the ICTUS 2/3 study of induced hypothermia for large ischemic stroke. I am the principle investigator for the ATACH 2 trial, evaluating acute blood pressure lowering in acute intracerebral hemorrhage.
CLEAR III - study of intraventricular TPA for acute intraventricular hemorrhage
ATACH 2 - study of blood pressure lowering in acute intracerebral hemorrhage
ICTUS 2/3 - study of the use of induced hypothermia in acute ischemic stroke
- Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74(23):1911-8.
- Greer DM, Scripko P, Bartscher J, Sims, J, Camargo E, Singhal A, Furie K. Serial MRI Changes in Comatose Cardiac Arrest Patients. Neurocritical Care 2011;14(1):61-7.
- Wu O, Batista LM, Lima FO, Vangel MG, Furie KL, Greer DM. Predicting Clinical Outcome in Comatose Cardiac Arrest Patients using early non-contrast CT. Stroke 2011;42:985-92.