Charles Wira, MD
Associate Professor of Emergency MedicineCards
Appointments
Additional Titles
Liaison, Yale-New Haven Stroke Program
Contact Info
Appointments
Additional Titles
Liaison, Yale-New Haven Stroke Program
Contact Info
Appointments
Additional Titles
Liaison, Yale-New Haven Stroke Program
Contact Info
About
Titles
Associate Professor of Emergency Medicine
Liaison, Yale-New Haven Stroke Program
Biography
Dr. Wira is board certified in Internal and Emergency Medicine with specialization in Stroke and Emergency Critical Care. He provides clinical care in the Yale Department of Emergency Medicine (DEM) and also for the Division of Vascular Neurology in the Department of Neurology. He has performed influential research in the areas of stroke, sepsis, and cardiac arrest. Dr. Wira performed laboratory based cardiac arrest hypothermia studies in animal models that changed the 2010 AHA guidelines, he was a post-hoc member of the Early Goal Directed Collaborative Group which performed a landmark clinical trial at Henry Ford Hospital in Detroit, MI on septic shock patients, and is involved in multiple ischemic stroke clinical trials. Dr. Wira serves as Co-PI with Dr. Kevin Sheth (Neurology) for the Yale NETT (Neurological Emergencies Treatment Trials), a spoke of the Boston NETT Clinical Trials Group. Drs Wira and Sheth brought the NETT to Yale—a NINDS funded phase III clinical trials network for neurological emergencies which represents a broad based collaboration between Emergency Medicine and Neurology. Dr. Wira and Dr Sheth also brought SIREN to Yale (Strategies to Innovate Emergency Care Clinical Trials Network) where Yale will serve as a Sub-Hub. Dr. Wira has also worked with groups evaluating predictors of symptomatic ICH in the setting of thrombolysis for acute stroke, is the creator of a Yale Septic Shock registry looking at physiologic predictors of disease escalation in sepsis, and is performing stroke systems of care research with leaders of the AHA/ASA Get-With-the-Guidelines-Stroke program.
Clinically, Dr. Wira has been a leading figure in the Yale Stroke Program, contributing to its growth, numerous awards, and recent certification as a Comprehensive Stroke Center. He also was the first to induce hypothermia in a cardiac arrest survivor both at Henry Ford Hospital and at Yale, working to bring this innovation into practice at Yale with Dr. Mark Siegel (Pulmonary Critical Care) and other faculty in different departments. Educationally, Dr. Wira has been an architect of Emergency Critical Care education in the DEM, receiving the “outstanding teaching” award for resident education, and serves as faculty research advisor for YSM thesis students, graduate students, and DEM residents.
Regionally and nationally, Dr. Wira has become a leader in Emergency Medicine. He has been appointed to the national Emergency Neurovascular Care Committee for the AHA/ASA, and is the first Emergency Medicine Physician to be elected as Chair of The NorthEast Cerebrovascular Consortium—a regional branch of the AHA/ASA striving to improve stroke-systems of care in the Northeast. He contributed towards revising the national Society of Academic Emergency Medicine (SAEM) policy statement on thrombolytic therapy, is a part of a senior writing group at SAEM publishing recommendations and producing state-of-the-art didactic sessions at national SAEM conferences regarding advanced stroke therapies, and served as a faculty contributor towards the creation of two new SAEM interest groups: the Emergency Medicine/Critical Care Medicine interest group and the Sex and Gender in Emergency Medicine interest group. Dr. Wira also has extensive involvement in state-wide stroke initiatives, having been formally appointed in 2014 by Senate Majority Leader Senator Martin M. Looney to the Connecticut Department of Health Stroke Task Force evaluating Stroke Systems of Care in Connecticut. In September 2015 he was appointed as Chair of this Task Force by the Commissioner of Public Health Dr. Jewel Mullen and oversaw a series of recommendations by state leaders given to Senator Terry Gerrantana, Chair of the Public Health Committee of the Connecticut General Assembly. The continued efforts of this group in collaboration with the AHA/ASA culminated in the passage of Senate Bill 34, “An Act Concerning the Recognition of Stroke Centers” which was signed into law by Governor Dannel Malloy in the spring of 2017 and will allocate preliminary funds to the Connecticut DOH for oversight of a state-wide system of care.
Appointments
Emergency Medicine
Associate Professor on TermPrimary
Other Departments & Organizations
Education & Training
- Resident
- Henry Ford Hospital (2005)
- MD
- Dartmouth School of Medicine (2000)
- BS
- University of New Hampshire (1993)
Research
Overview
Medical Subject Headings (MeSH)
ORCID
0000-0002-1041-4165
Research at a Glance
Yale Co-Authors
Publications Timeline
Research Interests
Joseph Schindler, MD
Kevin Sheth, MD
Emily J. Gilmore, MD, FNCS, FACNS
Rachel Beekman, MD
Charles Matouk, MD
Lauren Hachmann Sansing, MD, MS, FAHA, FANA
Stroke
Sepsis
Heart Arrest
Emergency Medicine
Publications
2024
Temperature Control Parameters Are Important: Earlier Preinduction Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest
Beekman R, Kim N, Nguyen C, McGinniss G, Deng Y, Kitlen E, Garcia G, Wira C, Khosla A, Johnson J, Miller P, Perman S, Sheth K, Greer D, Gilmore E. Temperature Control Parameters Are Important: Earlier Preinduction Is Associated With Improved Outcomes Following Out-of-Hospital Cardiac Arrest. Annals Of Emergency Medicine 2024, 84: 549-559. PMID: 39033449, DOI: 10.1016/j.annemergmed.2024.06.007.Peer-Reviewed Original ResearchCitationsAltmetricConceptsOut-of-hospital cardiac arrestNeurological outcomeDevice cohortCardiac arrestOut-of-hospital cardiac arrest patientsConsecutive out-of-hospital cardiac arrestPreinduction timeInterquartile rangeAssociated with improved outcomesCardiac arrest patientsProportion of patientsMultivariate logistic regression modelInverse probability of treatmentDevice timeInverse probability treatment weightsProbability of treatmentProspective trialsOHCA patientsArrest patientsClinical outcomesLogistic regression modelsCenter studyEarly initiationSecondary outcomesTreatment weightingConsidering Adverse Effects of Common Antihypertensive Medications in the ED
Wira C, Kearns T, Fleming-Nouri A, Tyrrell J, Wira C, Aydin A. Considering Adverse Effects of Common Antihypertensive Medications in the ED. Current Hypertension Reports 2024, 26: 355-368. PMID: 38687403, DOI: 10.1007/s11906-024-01304-5.Peer-Reviewed Original ResearchCitationsCan Clinical Scores Predict the Presence of Hypoxic Ischemic Brain Injury on Early Head Computed Tomography After Cardiac Arrest? (P6-2.001)
Nguyen C, Molligoda B, Kim N, Kitlen E, Wira C, Perman S, Khosla A, Miller P, Greer D, Gilmore E, Beekman R. Can Clinical Scores Predict the Presence of Hypoxic Ischemic Brain Injury on Early Head Computed Tomography After Cardiac Arrest? (P6-2.001). Neurology 2024, 102 DOI: 10.1212/wnl.0000000000206255.Peer-Reviewed Original ResearchThe Impact of Socioeconomic Status on Risk for Brain Death Following Out-of-Hospital Cardiac Arrest (P1-4.014)
Fung C, Kitlen E, Nguyen C, Kim N, Wira C, Perman S, Khosla A, Miller P, Greer D, Gilmore E, Beekman R. The Impact of Socioeconomic Status on Risk for Brain Death Following Out-of-Hospital Cardiac Arrest (P1-4.014). Neurology 2024, 102 DOI: 10.1212/wnl.0000000000206574.Peer-Reviewed Original Research
2023
Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke
Forman R, Okumu R, Mageid R, Baker A, Neu D, Parker R, Peyravi R, Schindler J, Sansing L, Sheth K, de Havenon A, Jasne A, Narula R, Wira C, Warren J, Sharma R. Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke. Neurology 2023, 102: e207764. PMID: 38165368, PMCID: PMC10834135, DOI: 10.1212/wnl.0000000000207764.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsEmergency department arrival timesEmergency medical servicesLate presentationAcute ischemic stroke therapyYale-New Haven HospitalGuidelines-Stroke registryNeighborhood-level socioeconomic factorsPatient-level factorsRetrospective observational studyIschemic stroke therapyMixed-effects logistic regression modelNon-white patientsNon-white raceUnivariate logistic regressionNew Haven HospitalLogistic regression modelsHospital presentationTreatment ineligibilityStroke RegistryAcute strokeHospital arrivalStroke therapyUnivariate analysisObservational studyPatientsDevelopment and validation of a novel score to predict brain death after out-of-hospital cardiac arrest
Kitlen E, Kim N, Rubenstein A, Keenan C, Garcia G, Khosla A, Johnson J, Miller P, Wira C, Greer D, Gilmore E, Beekman R. Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest. Resuscitation 2023, 192: 109955. PMID: 37661012, DOI: 10.1016/j.resuscitation.2023.109955.Peer-Reviewed Original ResearchCitationsMeSH Keywords and ConceptsConceptsHospital cardiac arrestBrain deathCardiac arrestOptimal cutEtiology of arrestDeath risk scoreNon-shockable rhythmOperator characteristic curveHours of arrestCenter cohortIndependent predictorsSulcal effacementUnResponsiveness (FOUR) scoreValidation cohortDevelopment cohortMAIN OUTCOMEHigh riskRisk scoreAcademic centersNovel scoreOHCACohortInternal validationRadiology reportsCharacteristic curveIdentification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging
de Havenon A, Parasuram N, Crawford A, Mazurek M, Chavva I, Yadlapalli V, Iglesias J, Rosen M, Falcone G, Payabvash S, Sze G, Sharma R, Schiff S, Safdar B, Wira C, Kimberly W, Sheth K. Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging. Journal Of The American Heart Association 2023, 12: e029242. PMID: 37218590, PMCID: PMC10381997, DOI: 10.1161/jaha.122.029242.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsWhite matter hyperintensitiesMagnetic resonance imagingSevere white matter hyperintensitiesConventional magnetic resonance imagingResonance imagingRetrospective cohortEmergency departmentMatter hyperintensitiesVascular risk factorsProspective observational studyVascular cognitive impairmentTesla magnetic resonance imagingArea Deprivation IndexProspective cohortAdult patientsAcute careRisk factorsCardiovascular diseaseObservational studyCognitive impairmentPatientsCare magnetic resonance imagingIntermodality agreementCohortDeprivation indexValidation of the rCAST score and comparison to the PCAC and FOUR scores for prognostication after out-of-hospital cardiac arrest
Kim N, Kitlen E, Garcia G, Khosla A, Miller P, Johnson J, Wira C, Greer D, Gilmore E, Beekman R. Validation of the rCAST score and comparison to the PCAC and FOUR scores for prognostication after out-of-hospital cardiac arrest. Resuscitation 2023, 188: 109832. PMID: 37178901, DOI: 10.1016/j.resuscitation.2023.109832.Peer-Reviewed Original ResearchCitationsMeSH Keywords and ConceptsConceptsPoor neurologic outcomeUnited States cohortHospital cardiac arrestOHCA patientsNeurologic outcomeCardiac arrestPost-cardiac arrest syndromePoor neurological outcomeScore predictive abilityHospital mortalityNeurological outcomeUnResponsiveness (FOUR) scorePoor outcomeRetrospective studyAccurate outcome predictionPrognostic performanceFull OutlineDeLong testOutcome predictionPatientsMortalityOutcomesScoresCohortPredictive abilityDiagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association
Amin H, Madsen T, Bravata D, Wira C, Johnston S, Ashcraft S, Burrus T, Panagos P, Wintermark M, Esenwa C, Disease O. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023, 54: e109-e121. PMID: 36655570, DOI: 10.1161/str.0000000000000418.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsTransient ischemic attackIschemic attackMaximal medical therapyHigh-risk patientsCorrect clinical diagnosisRisk stratification scaleAmerican Heart AssociationEmergency department settingFuture cerebrovascular eventsScientific statementTime of evaluationCerebrovascular eventsSecondary preventionStroke riskMedical therapyNeurological examinationAcute phaseIndex eventHeart AssociationDepartment settingPatient educationAncillary testingCerebral vasculatureConfirmatory testingClinical diagnosis
2021
Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis
Wu X, Wira C, Matouk C, Forman H, Gandhi D, Sanelli P, Schindler J, Malhotra A. Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis. International Journal Of Stroke 2021, 17: 315-322. PMID: 33759645, DOI: 10.1177/17474930211008701.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsComprehensive stroke centerPrimary stroke centerAcute stroke patientsNearest comprehensive stroke centerAcute strokeMothership strategyStroke centersStroke patientsPlace of onsetHealth benefitsMarkov decision-analytic modelComparative effectiveness analysisRecent medical literatureMultiple sensitivity analysesDecision analytic modelMothership modelPrimary outcomeEndovascular treatmentPrehospital triageSudden onsetPatientsMedical literatureStrokeShip strategyTarget population
Clinical Trials
Current Trials
Blood PREssure Augmentation in Large-vessel Occlusion Stroke Study (PRESS)
HIC ID2000022525RoleSub InvestigatorPrimary Completion Date04/30/2019Recruiting ParticipantsGenderBothAge18+ yearsBrain Oxygen Optimization in Severe TBI, Phase 3 (BOOST3)
HIC ID2000024956RoleSub InvestigatorPrimary Completion Date07/01/2023Recruiting ParticipantsGenderBothAge14+ yearsCrystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS)
HIC ID2000023369RolePrincipal InvestigatorPrimary Completion Date05/04/2022Recruiting ParticipantsGenderBothAge18+ years
Academic Achievements & Community Involvement
honor Member, Stroke Council Leadership Committee
National AwardAHA/ASADetails10/16/2020United Stateshonor Chair, Emergency Neurovascular Care Committee
National AwardAHA/ASADetails07/01/2020United Stateshonor Chair
Regional AwardState of Connecticut Stroke Task ForceDetails11/03/2016United Stateshonor Chair
Regional AwardNorthEast Cerebrovascular Consortium (NorthEast AHA/ASA)Details10/22/2014United Stateshonor 2011 Residency Teacher of the Year--Yale DEM
Yale School of Medicine AwardYale DEM ResidentsDetails06/22/2011United States
Clinical Care
Overview
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Board Certifications
Emergency Medicine
- Certification Organization
- AB of Emergency Medicine
- Latest Certification Date
- 2017
- Original Certification Date
- 2006
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