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

Christopher Wilcox; Matthew Acton; Hannah Rando; Steven Keller; Haris I Sair; Ifeanyi Chinedozi; John Pitts; Bo Soo Kim; Glenn Whitman; Sung Min Cho

doi:10.3390/diagnostics12112871

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

Diagnostics (Basel). 2022 Nov 19;12(11):2871. doi: 10.3390/diagnostics12112871.

Authors

Christopher Wilcox^{1

2}, Matthew Acton¹, Hannah Rando¹, Steven Keller^{1

3

4}, Haris I Sair⁵, Ifeanyi Chinedozi¹, John Pitts⁶, Bo Soo Kim¹, Glenn Whitman¹, Sung Min Cho^{1

7}

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
² Division of Critical Care, Department of Medicine, Mercy Hospital of Buffalo, Buffalo, NY 14220, USA.
³ Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
⁴ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
⁵ Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
⁶ Hyperfine, Inc., Guilford, CT 06437, USA.
⁷ Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Abstract

(1) Background: Fifty percent of patients supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are concurrently supported with an intra-aortic balloon pump (IABP). Acute brain injury (ABI) is a devastating complication related to ECMO and IABP use. The standard of care for ABI diagnosis requires transport to a head CT (HCT) scanner. Recent data suggest that point-of-care (POC) magnetic resonance imaging (MRI) is safe and may be effective in diagnosing ABI in ECMO patients; however, no data exist in patients supported on ECMO with an IABP. We report pre-clinical safety data and a case series to evaluate the safety and feasibility of POC brain MRI in ECMO patients supported with IABP. (2) Methods: Prior to patient use, ex vivo testing with an IABP catheter within the Swoop^® Portable MRI (0.064 T) System™ was conducted. After IRB approval, clinical testing was performed for the safety and feasibility of early ABI detection. (3) Results: No deflection force was measured with a 7.5 French Maquet Linear IABP within the 0.064 T field. Three adult ECMO patients (average age: 40 years; 67% female) supported with IABP completed four POC brain MRI exams (median exam time: 30 min). Multiple signal abnormalities were detected on the POC brain MRI, corresponding to HCT results. (4) Conclusions: Our preliminary results suggest that adult VA-ECMO patients with IABP support can be safely imaged with low-field POC brain MRI in the intensive care unit, allowing for the early and bedside imaging of patients.

Keywords: ECMO; IABP; VA ECMO; brain injury; neuroimaging; portable MRI; safety.

Abstract

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