Common Consent Elements for Research Involving Persons with Disorders of Consciousness (CCE-DOC), new in @NeurocritCareJ @CuringComa link.springer.com/article/10… #neurology #neuroethics

Supratentorial Brain Lesions in Unconscious Patients Map to a Common Human Brain Circuit that connects the fronto-insular-limbic association cortex with subcortical arousal nodes and the ventral striato-pallidal circuitry This observation has zero direct clinical relevance as of now -- but it might in the future. #curingcoma onlinelibrary.wiley.com/doi/…

#ICECAP is out. This NIH-funded RCT compared different durations of cooling (12-72 hours) after cardiac arrest and found no impact of longer cooling inervals on survival or functional outcome. But there was no arm without TTM at all -- which is what many centers have now reverted to.... #curingcoma

Nice summary of best #TTM practices in neurocritical care. Please note that proactive TTM for any target 32-37.5 °C and avoidance of fever is the best prioactice for cardiac arrest. Don't let them spike and then chase the fevers... #curingcoma link.springer.com/article/10…

It turns out that infratentorial ICP monitoring is feasible, can identify ICP gradients, and offers superior prognostic information to standard supratentorial monitoring in patients with cerebellar mass effect. #curingcoma link.springer.com/article/10…

Case Fatality of Subarachnoid Hemorrhage differs by by Aneurysm Location. The highest case fatlaity rates are vertebrobasilar (54%) and MCA (40%), followed by A-comm (29%) and ICA (28%). The majority of excess deaths with Vb and MCA aneurysms is due to pre-hospital sudden death. About 1/3 of all SAH-related mortality is due to sudden pre-hospital cardia arrest. #curingcoma |neurology.org/doi/10.1212/WN…

Rapid response teams are going to become more sophisticated and critical-care capable. Like slamming R heart catheters into inetermediate to submassive PE patirents: @nejm -- Right-sided Ultrasound-Mediated Catheter-Directed Fibrinolysis (EkoSonic) for Intermediate-Risk Acute Pulmonary Embolism -- in addition to standard anticoagulation. Primary outcome: Death, cardiopulmonary collapse, or recurrent PE in <7 days: With UMCDF: 4% Standard care: 10% Effect driven by lower risk of cardiopulmonary collapse. #curingcoma nejm.org/doi/full/10.1056/NE…

Did you know March 22 was World Coma Day? check out my talk on patient and caregiver empowerment #curingcoma @neurocritical youtu.be/e2Sx-dXo9PM?si=FhuW…

As documented in this GWTG analysis, when anticoagulation-associated #ICH patients are transferred, it leads to a massive increase in onset-to-treatment time: Transfer: 512 mins (~10 hours) No transfer: 273 mins (4.5 hours) Both of these are awful of course. About 1/3 of those transferred didn't get reversed until arriving at the 2nd hospital. That should never happen! #curingcoma #codeich ahajournals.org/doi/pdf/10.1…

A single center non-randomized real world look at Minimally invasive surgery for large #ICH • 38 underwent MIS • 61 had open surgery Those treated with MIS had: • Better outcomes (favorable 6 mo mRS 40% at 15%) • Lower mortality (0% vs 15%) • Higher excellent clot evacuation (90% vs 80%) • Shorter ICU length of stay (5.5 vs 7.0 days) Do you perform MIS for ICH at your site? #codeich #curingcoma sciencedirect.com/science/ar…

Endovascular vs Medical Treatment of Basilar Artery Occlusion @JAMANeuro “At 3 years, the clinical benefit of EVT in patients with acute BAO was durable, with substantially better functional outcomes and reduced mortality compared with medical management. These results reinforce EVT as the standard of care for BAO and support broader implementation and timely access to thrombectomy services.” #curingcoma jamanetwork.com/journals/jam…

What are your plans for World Coma Day 2026? Drop it in the comments section 🤝🙌 #CuringComa

2/ As some of you may know, I am very interested in the topic of #CovertConsciousness and do believe this will become a major player in our ability to better prognosticate in #coma patients. I suspect the future of #neuroritcare will be around this. #CuringComa.

1/ 👋 there #neurotwitter #neurosky #neurocritcare, as part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/article/10… about #covertconsciousness and #NIRS! #CuringComa

Another new publication by the great team at @nymedcollege @WMCHealth @nymcbrainspine In this retrospective cohort study of 10,375 adult patients with ruptured AVMs, vasospasm occurred in approximately 3%. Risk factors for vasospasm included subarachnoid hemorrhage, male sex, hydrocephalus, and leukocytosis. Delayed arterial spasm more than doubles the risk of mortality at 3, 6, and 12 months. Perhaps continuous ventricular irrigation (e.g. IRRAFlow) can be a better way when large amounts of IVH are present? #curingcoma link.springer.com/article/10…

I really get excited about high-impact papers. This one is an instant classic. The investigators surveyed ~250 TBI survivors and ~250 TBI caregivers, an average of 12 years after the injury. They asked – what is the minimally acceptable outcome that is acceptible after severe TBI? Both survivors and care givers agreed –– recovery of yes/no communication is the basic common denominator. Being able to have any semblance of control about what happens to you. A basic human right, worth experiencing. So interesting. In my ICU end of life conversations moving forward, I am going to use "yes/no" and "following commands" in equal balance when descibing MCS/coma outcomes. Saying yes or no –– sounds a way lot better than following commands. #curingcoma @HarvardHealth @VUMCDiscoveries Perspectives of Persons With Lived Experience on Acceptable ... : Critical Care Medicine journals.lww.com/ccmjournal/…

Get ready for this. These Chinese investigators report a cohort of 121 malignant MCA infarction patients age >60, 47 of whom underwent drill-assisted sterotactic aspiration of the infarcted tissue from 24-72 hrs after onset. Check out the CT images and the 70 mL of nectrotic brain tissue in the image below to give you an idera of what they were doing. Retrospective, not randomized -- but the results were great. Herniation: 47% vs 9% Death: 65% vs 9% Favorable mRS (0-3): 3% vs 26% Not only #curingcoma –– cheating death. pmc.ncbi.nlm.nih.gov/article…

Here's a free PDF of a recent editorial in Intensive Care Medicine outling some of the nuances of using a lumbar drain in addition to a ventricular drain in high-grade SAH with significant amounts of IVH. Very enlightening! Makes me want to try this out... #curingcoma boa.unimib.it/bitstream/1028…

link.springer.com/article/10… I wanted to share our latest study (last study fully completed at Phoenix Children's, before I left), now published in Neurocritical Care, where we demonstrated a method using EEG to detect signs of covert conscious processing in comatose-appearing critically ill children. Access to the full article can be seen here: rdcu.be/e3xW3 This study was difficult and challenging - probably the most challenging study I've done at this point in my career. Everything that could've gone wrong did go wrong. There were many points where I thought the study would halt, but it was seen to the end, and now it's complete and published. Thanks to everyone who supported this work, especially my co-authors. @PNCRGtweets @CuringComa @NeurocritCareJ @neurocritical

Welcoming Dr David Fischer front left) to ⁦@NeurologyNymc⁩ Grand Rounds today! Great talk on coma prognostication #curingcoma ⁦@PennNeurology⁩ ⁦@WMCHealth⁩ ⁦@almuftifawaz⁩ ⁦@A_Bauerschmidt⁩