Assessing the SAfety and FEasibility of bedside portable low-field brain Magnetic Resonance Imaging in patients on ECMO (SAFE-MRI ECMO study): study protocol and first case series experience

Abstract

Background To assess the safety and feasibility of imaging of the brain with a point-of-care (POC) magnetic resonance imaging (MRI) system in patients on extracorporeal membrane oxygenation (ECMO). Early detection of acute brain injury (ABI) is critical in improving survival for patients with ECMO support. Methods Patients from a single tertiary academic ECMO center who underwent head CT (HCT), followed by POC brain MRI examinations within 24 h following HCT while on ECMO. Primary outcomes were safety and feasibility, defined as completion of MRI examination without serious adverse events (SAEs). Secondary outcome was the quality of MR images in assessing ABIs. Results We report 3 consecutive adult patients (median age 47 years; 67% male) with veno-arterial (n = 1) and veno-venous ECMO (n = 2) (VA- and VV-ECMO) support. All patients were imaged successfully without SAEs. Times to complete POC brain MRI examinations were 34, 40, and 43 min. Two patients had ECMO suction events, resolved with fluid and repositioning. Two patients were found to have an unsuspected acute stroke, well visualized with MRI. Conclusions Adult patients with VA- or VV-ECMO support can be safely imaged with low-field POC brain MRI in the intensive care unit, allowing for the assessment of presence and timing of ABI.

Safety of Bedside Portable Low-Field Brain MRI in ECMO Patients Supported on Intra-Aortic Balloon Pump

“…We previously reported that adult patients supported on VA- and VV-ECMO can be safely imaged with a low-field POC brain MRI at the bedside in an ICU setting [ 6 ]. However, a significant proportion of ECMO patients were not enrolled in our study due to the concurrent use of IABP with no available safety data.…”

“…Additionally, no ABI were detected on POC brain MRI imaging, corresponding to clinical HCT results. In our previous report, we collected four MR sequences: T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging with an apparent diffusion coefficient map (DWI ADC), which resulted in an average exam time of 39 minutes [ 6 ]. In this study, the T1 sequence was eliminated, resulting in an average run time of 33 min, without a compromise in diagnostic ability.…”

“…The study procedures were previously reported in our prior study [ 6 ]. A POC brain MRI was obtained using the 64 mT Swoop ® MR imaging system (MK 1.6, Hyperfine, Inc., Guilford, CT, USA).…”

“…Recent advances in low-field (0.064 T), portable MRI technology enable the acquisition of clinically meaningful imaging in the presence of ferromagnetic materials. We have previously demonstrated the safety and feasibility of low-field point-of-care (POC) MRI to obtain brain imaging in ECMO patients [ 6 ]. However, there are no safety data on POC MRI in ECMO patients who are supported on IABP.…”

Utilization of Portable Brain Magnetic Resonance Imaging in an Acute Care Setting

“…One study found pMRI to be effective in assessing brain injuries in critically ill patients diagnosed with COVID-19 [9]. Other studies have remarked on the safety, feasibility, and ease of obtaining point-of-care MRIs in various clinical settings using pMRI [10][11][12][13][14]. Furthermore, traditional MRI machines have a magnetic field of 1.5 or 3 T [15][16].…”