Professor & Head, Division of Anaesthesia, University of Cambridge Honorary Consultant, Neurocritical Care,
Professor & Head, Division of Anaesthesia, University of Cambridge (since 2000).
Deputy Divisional Director, Emergency and Perioperative Care, Addenbrooke’s Hospital, Cambridge
Honorary Consultant, Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge.
Principal Investigator, Wolfson Brain Imaging Centre, University of Cambridge.
Principal Investigator, Van Geest Centre for Brain Repair, University of Cambridge
Trustee & Member, Board of Management, Intensive Care National Audit and Research Centre (UK)
Emeritus Senior Investigator, National Institute of Health Research, UK
Professorial Fellow in the Medical Sciences, Queens’ College Cambridge
Chair, European Brain Injury Consortium Member, Executive Committee, International NeuroTrauma Society
Tripartite Leadership Committee, International Traumatic Brain Injury Research (InTBIR) initiative
On behalf of the neurosciences and trauma critical care consultant group, the Cambridge acute brain injury research group, and the wider anaesthesia and critical care community in Cambridge we would like to nominate Professor Menon for the NACCS Lifetime Achievement Award.
We believe this award is richly deserved due to Prof Menon’s contribution to clinical medicine, research, training, and service improvement relevant to neuroanaesthesia and critical care, amongst many other fields.
Throughout his career, Professor Menon has substantially and continuously contributed to specialty development, training, research, public and policy engagement, and leadership in neurocritical care, acute brain injury, and neuroanaesthesia.
Highlights of his career include setting up the Cambridge Neurosciences Critical Care Unit (NCCU) and Cambridge Acute Brain Injury (ABI) Group. Within NCCU he established the first specialist training program for neurocritical care in the UK and has been responsible for training many of the current clinical leaders in the specialty both within the UK and abroad.
He was a Founding Fellow of the Academy of Medical Sciences in the UK and a Founding Member of the Board of the Faculty of Intensive Care Medicine and has held several roles at the Royal College of Anaesthesia.
Within the NHS and research sectors in Cambridge he developed academic anaesthesia and intensive care within the University, including supervision of trainee doctors from a range of specialities, scientists, and nurses for higher degrees. Many of those former trainees are now consultant colleagues within Cambridge and the East of England and span anaesthesia, critical care, neurology, neurosurgery, emergency medicine, respiratory medicine, and orthopaedic surgery.
Operationally, he has established a research network clustered around NCCU. The unit has close links with the Brain Physics Group at the University and the Wolfson Brain Imaging Centre (WBIC), for example. Professor Menon was integral to establishing the WBIC from its inception, including developing process and procedures for early imaging of patients with acute brain injury, and continues to work closely with co-workers in the facility. From a clinical perspective, this has meant that patients from NCCU always have easy access to essential imaging modalities which has proved essential during the current COVID pandemic.
Since 2000 the ABI Group, headed by Professor Menon, has published over 500 indexed publications, and supported over 25 PhD studentships as well as providing mentorship to local and regional academics. ExpertScape rates him as the number one expert, worldwide, in brain injury putting him in the top 0.0011% of published authors in the area (data: 22/09/2020).
Outside of Cambridge he currently acts as joint-PI and Vice Co-ordinator of the CENTER-TBI project, a €30 million European multicenter study of precision medicine and comparative effectiveness research in traumatic brain injury (TBI). He is the global coordinator of the Genetics Association in Neurotrauma which studies the impact of genetic variation on various outcomes after TBI (combining the two largest existing multicenter international cohorts of severe TBI in Europe and USA).
Professor Menon sits on the International neurotrauma society advisory committee and is chair of the European Brain Injury Consortium (EBIC).
He is PI or co-investigator on peer-reviewed grants totaling $50 million. He has over 400 peer reviewed publications with an h-index over 65 and was one of two lead authors on a Commissioned Issue of the Lancet Neurology on Traumatic Brain injury. His work has been used to brief legislators, regulators, and research funders, and through public engagement activity educate children and adults in the fields of TBI and disorders of consciousness.
His clinical work is outstanding and he provides world class clinical care within NCCU. He is regularly consulted about challenging cases from within Cambridge, the UK, and globally and teaches and lectures frequently around the world but consistently maintains a highly visible local presence, for example teaching every year at the NCCU Neuro and Trauma Study Day in Cambridge.
He is a kind, wise colleague who has supported many colleagues through a range of personal and professional challenges and he consistently manages to rise above local politics, personal differences, and the maze-like hospital community to be seen as a trusted and candid confident and mentor.
We cannot think of anyone else more deserving of this award and it comes with our strongest recommendation.
We attach supporting information from Prof Menon’s CV.
The first in vivo demonstration of neuronal loss in clinical AIDS
The first 19F MR spectroscopy studies of volatile anaesthetic agents in humans
The first fMRI study of drug effects on regional cerebral blood flow
The first use of functional imaging to document cognitive processing in the persistent vegetative state
Demonstration of the impact of specialist neurocritical care on outcome in TBI
The first conclusive demonstration of regional ischaemia in TBI
The first documentation of decreased oxidative brain metabolism with hyperventilation for intracranial hypertension
The first demonstration of enhanced cerebral oxidative metabolism with normobaric hyperoxia in TBI
The first documentation of diffusion barrier hypoxia as a pathophysiological mechanism in TBI
The current international definition of TBI
The first validated use of positron emission tomography to image amyloid deposition in TBI
A randomized controlled trial of decompressive craniectomy for refractory intracranial hypertension in TBI
A Lancet Neurology Commission on TBI, providing a resource for clinicians, funders, and policy makers
Sir Robert Macintosh Medal, Royal College of Anaesthetists, 1988.
Founding Fellow, Academy of Medical Sciences, UK, 1998.
Jubilee Fellowship Award, Royal College of Anaesthetists, 1998.
Lewin Lecturer, University of Cambridge, 2000.
Charles Sherrington Professor, Royal College of Anaesthetists, 1999-2000.
Datex-Ohmeda Lecturer, Association of Anaesthetists, UK, 2003
Visiting Professor, Critical Care Unit, University of Alberta at Calgary, 2003.
Foundation Visitor, Australian and New Zealand College of Anaesthetists, 2005
Ellis Gillespie Lecturer, Australia and New Zealand College of Anaesthetists, 2005
Mary Bunnell Brown Lecturer, Australia and New Zealand College of Anaesthetists, 2005
British Oxygen Professor of Anaesthesia, Royal College of Anaesthetists 2006
Visiting Professor and Marshall Lecturer, University of Toronto, 2007
Visiting Professor, Harvard Medical School, 2008
Senior Investigator, National Institute for Health Research, UK, 2009
Founding Member, Board of the Faculty of Intensive Care Medicine, 2010
Visiting Professor, University of California, San Francisco, 2013
Laerdal Award & Lectureship, Scandinavian Society of Anaesthesiology & Intensive Care Medicine, 2013
Addenbrooke’s Charities Trust Annual Lecture, 2013
William J. Sibbald Visiting Professor, University of Toronto and Western University, 2016
Honorary Membership of the Neurocritical Care Society, 2016
Emeritus Senior Investigator, National Institute for Health Research, 2018
Ake and Inge Grenvik Visiting Professor, University of Pittsburgh, 2019
Distinguished Investigator-elect, American College of Critical Care Medicine, 2020
Selected contributions to research: Imaging acute pathophysiology in traumatic brain injury:
The failure of translation of preclinical successes to clinical care has been a recurring theme in traumatic brain injury. One major cause of this failure was the assumption that pathophysiology in experimental models was directly relevant to human TBI. Professor Menon’s group in Cambridge has articulated a philosophy of addressing human pathophysiology directly using both bedside monitoring techniques and advanced neuroimaging (including advanced magnetic resonance imaging [MRI] and spectroscopy, along with positron emission tomography [PET]). These techniques recognize the regional variations in pathophysiology in the injured brain, and have allowed us to publish seminal papers which document the presence of true ischaemia in early TBI; establish the presence of diffusion barrier hypoxia as an important pathophysiological mechanism in TBI; and understand the impact of commonly used intensive care therapies such as blood pressure elevation and hyperventilation. Alongside these PET studies, he has used advanced MRI to understand pathophysiology evolution.
Coles JP, Fryer TD, Smielewski P, Chatfield DA, Steiner LA, Johnston AJ, Downey SP, Williams GB, Aigbirhio F, Hutchinson PJ, Rice K, Carpenter TA, Clark JC, Pickard JD, Menon DK. Incidence and mechanisms of cerebral ischemia in early clinical head injury. J Cereb Blood Flow Metab. 2004 Feb;24(2):202-11. PMID: 14747747.
Menon DK, Coles JP, Gupta AK, Fryer TD, Smielewski P, Chatfield DA, Aigbirhio F, Skepper JN, Minhas PS, Hutchinson PJ, Carpenter TA, Clark JC, Pickard JD. Diffusion limited oxygen delivery following head injury. Crit Care Med. 2004 Jun;32(6):1384-90. PMID: 15187523.
Veenith TV, Carter EL, Geeraerts T, Grossac J, Newcombe VF, Outtrim J, Gee GS,Lupson V, Smith R, Aigbirhio FI, Fryer TD, Hong YT, Menon DK, Coles JP. Pathophysiologic mechanisms of cerebral ischemia and diffusion hypoxia in traumatic brain injury. JAMA Neurol 2016;73(5):542-50. PMID: 27019039
Newcombe VF, Williams GB, Outtrim JG, Chatfield D, Gulia Abate M, Geeraerts T, Manktelow A, Room H, Mariappen L, Hutchinson PJ, Coles JP, Menon DK. Microstructural basis of contusion expansion in TBI: insights from diffusion tensor imaging. J Cereb Blood Flow Metab 2013;33(6):855-62. PMID: 23423189.
Launey Y, Fryer TD, Hong YT, Steiner LA, Nortje J, Veenith TV, Hutchinson PJA, Ercole A, Gupta AK, Aigbirhio FI, Pickard JD, Coles JP, Menon DK. Spatial and Temporal Pattern of Ischemia and Abnormal Vascular Function Following Traumatic Brain Injury. JAMA Neurol. 2020;77(3):339-349. PMID: 31710336
Multimodality bedside monitors for clinical care and research in critically ill patients with brain injury:
Professor Menon’s group has, in collaboration with the Division of Neurosurgery at Cambridge, pioneered the use of multimodality bedside monitoring, using signal processing of intracranial pressure waveforms, along with brain oximetry and microdialysis. His publications have validated key bedside monitors against the ground truth of positron emission tomography, and described novel indices of cerebrovascular reactivity. These indices have been shown to correlate with outcome, allow individualization of therapy targets, and are now in the process of being evaluated in trials. These data have informed rational responses to unexpected trial results and trans-Atlantic clinical guideline development, some of which he has jointly led. These monitoring tools have also allowed his team to directly characterize human metabolism following TBI (showing, for example, that the injured brain metabolizes lactate as a fuel), examine the local cerebral host response following injury (studying cytokine responses in brain microdialysate), and evaluate the impact of existing and novel therapies in patients with TBI.
Steiner LA, Czosnyka M, Piechnik SK, Smielewski P, Chatfield D, Menon DK, Pickard JD. Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury. Crit Care Med 2002; 30(4):733-8. PMID: 11940737.
Aries MJ, Czosnyka M, Budohoski KP, Steiner LA, Lavinio A, Kolias AG, Hutchinson PJ, Brady KM, Menon DK, Pickard JD, Smielewski P. Continuous determination of optimal cerebral perfusion pressure in traumatic brain injury. Crit Care Med 2012;40(8):2456-63. PMID: 22622398.
Sorrentino E, Diedler J, Kasprowicz M, Budohoski KP, Haubrich C, Smielewski P, Outtrim JG, Manktelow A, Hutchinson PJ, Pickard JD, Menon DK, Czosnyka M. Critical thresholds for cerebrovascular reactivity after traumatic brain injury. Neurocrit Care 2012;16(2):258-66. PMID: 21964774.
Helmy A, Guilfoyle MR, Carpenter KL, Pickard JD, Menon DK, Hutchinson PJ. Recombinant human interleukin-1 receptor antagonist in severe traumatic brain injury: a phase II randomized control trial. J Cereb Blood Flow Metab 2014;34(5):845-51. PMID:24569690; PMC4013762.
Acute and chronic tissue outcomes in TBI:
Professor Menon has also piloted and developed advanced neuroimaging to understand the neurological basis of tissue fate and outcome following TBI. A key paper from his group identified acute physiological thresholds for late tissue injury, and subsequent papers showed that diffusion tensor and functional MRI could be used to identify the microstructural abnormalities and functional disconnections that underpinned late deficits. More recently, he has shown that these imaging changes can be progressive in a subset of patients, and that such imaging progression correlates with trajectories of clinical improvement or deterioration. These data provide an important basis for developing biomarkers that can be used to explore the growing problem of TBI as a chronic, progressive disease in a minority of survivors. More recently, he has pioneered the use of PET to image some of the pathophysiological processes, such as amyloid deposition, which may underlie such progressive deterioration.
Cunningham AS, Salvador R, Coles JP, Chatfield DA, Bradley PG, Johnston AJ, Steiner LA, Fryer TD, Aigbirhio FI, Smielewski P, Williams GB, Carpenter TA, Gillard JH, Pickard JD, Menon DK. Physiological thresholds for irreversible tissue damage in contusional regions following TBI. Brain 2005 Aug;128(Pt 8):1931-42. PMID: 15888537.
Newcombe VF, Outtrim JG, Chatfield DA, Manktelow A, Hutchinson PJ, Coles JP, Williams GB, Sahakian BJ, Menon DK. Parcellating the neuroanatomical basis of impaired decision-making in TBI. Brain. 2011 Mar;134(Pt 3):759-68. PMID: 21310727; PMC3044832.
Newcombe VF, Correia MM, Ledig C, Abate MG, Outtrim JG, Chatfield D, Geeraerts T, Manktelow AE, Garyfallidis E, Pickard JD, Sahakian BJ, Hutchinson PJ, Rueckert D, Coles JP, Williams GB, Menon DK. Dynamic Changes in White Matter Abnormalities Correlate With Late Improvement and Deterioration Following TBI: A Diffusion Tensor Imaging Study. Neurorehabil Neural Repair. 2016 Jan;30(1):49-62. PMID: 25921349.
Hong YT, Veenith T, Dewar D, Outtrim JG, Mani V, Williams C, Pimlott S, Hutchinson PJ, Tavares A, Canales R, Mathis CA, Klunk WE, Aigbirhio FI, Coles JP, Baron JC, Pickard JD, Fryer TD, Stewart W, Menon DK. Amyloid imaging with carbon 11-labeled Pittsburgh compound B for TBI. JAMA Neurol. 2014 Jan; 71: 23-31. PMID:24217171; PMC4084932.
Improving clinical care in severe TBI through Comparative Effectiveness Research and pragmatic RCTs:
In a series of papers, Professor Menon has shown that centres in the UK were not following best practice in TBI management. He subsequently demonstrated, for the first time, that adoption of rational guidelines in a specialist neurocritical care setting could result in significant improvements in clinical outcome, with an increase in favourable outcomes from ~40% to ~60% following severe TBI. The protocols he developed based on his research and experience now form the basis of clinical management in many other UK and international centres. These inferences were subsequently supported by an independent audit of UK trauma outcomes. Professor Menon was clinical lead on the 3000 patient RAIN study which was conducted in collaboration with the UK Intensive Care National Audit and Research Centre. This Comparative Effectiveness Research Study, published in 2013, showed that transfer of patients with TBI to specialist neuroscience centres was cost effective, irrespective of the need for acute neurosurgical intervention. More recently, his group has used a pragmatic RCT platform to demonstrate a survival benefit and functional improvement from decompressive craniectomy in refractory intracranial hypertension.
Jeevaratnam DR, Menon DK. Survey of intensive care of severely head injured patients in the United Kingdom. BMJ. 1996 Apr 13;312(7036):944-7. PMID: 8616307.
Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ. Specialist neurocritical care and outcome from head injury. Intensive Care Med. 2002 May;28(5):547-53. PMID: 12029400.
Harrison DA, Prabhu G, Grieve R, Harvey SE, Sadique MZ, Gomes M, Griggs KA, Walmsley E, Smith M, Yeoman P, Lecky FE, Hutchinson PJ, Menon DK, Rowan KM. Risk Adjustment In Neurocritical care (RAIN)—prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care: a cohort study. Health Technol Assess. 2013 Jun;17(23):vii-viii, 1-350. PMID: 23763763; PMC4781166.
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ; RESCUEicp Trial Collaborators. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med. 2016 Sep 22;375(12):1119-30. PMID: 27602507.
International collaboration as a basis for improving TBI outcomes:
This theme of research has sought to provide a foundation for new ways of improving TBI outcomes through harmonized documentation in research studies and application of a range of approaches (such as Comparative Effectiveness Research and pragmatic Randomised Clinical Trials) to enable the practice of Precision Medicine and better outcomes in TBI. Professor Menon was part of the first NIH-NINDS process targeted at development of Common Data Elements in TBI, and lead author on the NIH-NINDS consensus definition on TBI. He was one of the lead authors on a consensus paper which re-orientated research strategy in TBI towards Comparative Effectiveness Research, and am currently one of two coordinators of the CENTER-TBI study, a €30 million European CER and Precision Medicine study in TBI, which is part of the International Traumatic Brain Injury Research initiative. He was joint first author* on a Special Commission on Traumatic Brain Injury in the Lancet Neurology, which targeted not just clinicians, but also policy makers and research funders, and was given the accolade of a personal profile published in the journal.
Maas AI*, Menon DK*, Lingsma HF, Pineda JA, Sandel ME, Manley GT. Re-orientation of clinical research in traumatic brain injury: report of an international workshop on comparative effectiveness research. J Neurotrauma. 2012 Jan 1;29(1):32-46. doi: 10.1089/neu.2010.1599. PMID: 21545277; PMC3253305.
Maas AI*, Menon DK*, Steyerberg EW, Citerio G, Lecky F, Manley GT, Hill S, Legrand V, Sorgner A; CENTER-TBI Participants and Investigators. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery. 2015 Jan;76(1):67-80. PMID: 25525693.
Maas AIR*, Menon DK*, et al; InTBIR Participants and Investigators. TBI: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017;16(12):987-1048. PMID: 29122524.
C, Buki A, Citerio G, De Keyser V, Ercole A, Kunzmann K, Lanyon L, Lecky F, Lingsma H, Manley G, Nelson D, Peul W, Stocchetti N, von Steinbüchel N, Vande Vyvere T, Verheyden J, Wilson L, Maas AIR, Menon DK; CENTER-TBI Participants and Investigators. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol 2019;18(10):923-934. PMID: 31526754.
Steyerberg EW, Wiegers E, Sewalt C, Buki A, Citerio G, De Keyser V, Ercole A, Kunzmann K, Lanyon L, Lecky F, Lingsma H, Manley G, Nelson D, Peul W, Stocchetti N, von Steinbüchel N, Vande Vyvere T, Verheyden J, Wilson L, Maas AIR, Menon DK, CENTER-TBI Participants and Investigators. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol. 2019;18(10):923-934.PMID: 31526754.
Research support active in last 5 years:
2013-2020 FP7 Program Menon/Mass (PIs) Collaborative European NeuroTrauma Effectiveness Research in TBI: CENTER-TBI
2017-2020 ERANET-NEURON Program Menon (PI and Coordinator) International Collaboration On Neuroinflammation in Traumatic Brain Injury: ICON-TBI
2017-2020 National Institute for Health Research Menon (Joint Director) NIHR Global NeuroTrauma Group.
2017-2020 Canadian Institute for Advanced Research Menon (PI) Brainstem arousal systems effects on consciousness