Matthew Acton

Johns Hopkins Medicine

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Hannah Rando

Johns Hopkins Medicine

Steven P. Keller

Johns Hopkins Medicine

Bo Soo Kim

Johns Hopkins Medicine

Christopher Wilcox

Mercy Hospital

Sung‐Min Cho

Johns Hopkins Medicine

Glenn Whitman

Johns Hopkins University

Errol L. Bush

Johns Hopkins University

Benjamin L. Shou

Johns Hopkins Medicine

Kate Calligy

Johns Hopkins University

Diane Alejo

Johns Hopkins Hospital

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Johns Hopkins University

Johns Hopkins Medicine

Johns Hopkins Hospital

Sağlık Bilimleri Üniversitesi

Baylor College of Medicine

Kartal Koşuyolu High Specialization Training and Research Hospital

University of Health Science

The University of Texas Health Science Center at Houston

The University of Texas Health Science Center at Tyler

Penn State Milton S. Hershey Medical Center

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

Diagnostics (2022)

Christopher Wilcox Matthew Acton Hannah Rando Steven P. Keller Haris I. Sair

(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.

10.3390/diagnostics12112871

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Clinical Use of Bedside Portable Low-field Brain Magnetic Resonance Imaging in Patients on ECMO: The Results from Multicenter SAFE MRI ECMO Study

Research Square (Research Square) (2024)

Sung‐Min Cho Shivalika Khanduja Christopher Wilcox Kha Dinh Jiah Kim

Abstract Purpose: Early detection of acute brain injury (ABI) is critical for improving survival for patients with extracorporeal membrane oxygenation (ECMO) support. We aimed to evaluate the safety of ultra-low-field portable MRI (ULF-pMRI) and the frequency and types of ABI observed during ECMO support. Methods: We conducted a multicenter prospective observational study (NCT05469139) at two academic tertiary centers (August 2022-November 2023). Primary outcomes were safety and validation of ULF-pMRI in ECMO, defined as exam completion without adverse events (AEs); secondary outcomes were ABI frequency and type. Results: ULF-pMRI was performed in 50 patients with 34 (68%) on venoarterial (VA)-ECMO (11 central; 23 peripheral) and 16 (32%) with venovenous (VV)-ECMO (9 single lumen; 7 double lumen). All patients were imaged successfully with ULF-pMRI, demonstrating discernible intracranial pathologies with good quality. AEs occurred in 3 (6%) patients (2 minor; 1 serious) without causing significant clinical issues. ABI was observed in ULF-pMRI scans for 22 patients (44%): ischemic stroke (36%), intracranial hemorrhage (6%), and hypoxic-ischemic brain injury (4%). Of 18 patients with both ULF-pMRI and head CT (HCT) within 24 hours, ABI was observed in 9 patients with 10 events: 8 ischemic (8 observed on ULF-oMRI, 4 on HCT) and 2 hemorrhagic (1 observed on ULF-pMRI, 2 on HCT). Conclusions: ULF-pMRI was shown to be safe and valid in ECMO patients across different ECMO cannulation strategies. The incidence of ABI was high, and ULF-pMRI may more sensitive to ischemic ABI than HCT. ULF-pMRI may benefit both clinical care and future studies of ECMO-associated ABI.

Stroke

10.21203/rs.3.rs-3858221/v1

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Citations (2)

Racial and ethnical discrepancy in hypoxemia detection in patients on extracorporeal membrane oxygenation

JTCVS Open (2023)

Andrew Kalra Benjamin L. Shou David Zhao Christopher Wilcox Steven P. Keller

To determine whether there is racial/ethnical discrepancy between pulse oximetry (SpO

Pulse Oximetry

Occult

Oxygen Saturation

10.1016/j.xjon.2023.02.011

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Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational study

JTCVS Techniques (2022)

Giorgio Caturegli Shrey Kapoor Vladimir Ponomarev Bo Soo Kim Glenn Whitman

Transcranial Doppler

10.1016/j.xjtc.2022.07.026

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The Successful Use of Extracorporeal Membrane Oxygenation in a Newly Diagnosed HIV Patient with Acute Respiratory Distress Syndrome (ARDS) Complicated by Pneumocystis and Cytomegalovirus Pneumonia: A Case Report

Emergency Care and Medicine (2024)

Jin Kook Kang Matthew Acton Bo Soo Kim

Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed with venovenous extracorporeal membrane oxygenation (VV-ECMO). Case Presentation: A 40-year-old patient with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing, where the patient was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Their pulmonary function quickly declined, necessitating mechanical ventilation (MV). After all conventional therapies failed, the patient was transferred to a tertiary medical center for VV-ECMO therapy. The patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of their respiratory symptoms. The patient was discharged on hospital day 82. Conclusions: HIV-positive patients with ARDS that is complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO.

Cytomegalovirus

Pneumocystis pneumonia

10.3390/ecm1040042

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Citations (1)

Characterization of Cerebral Hemodynamics with TCD in Patients Undergoing VA-ECMO and VV-ECMO: a Prospective Observational Study

Neurocritical Care (2022)

Giorgio Caturegli Lucy Q. Zhang Yunis Mayasi Aaron M. Gusdon Bahattin Ergin

10.1007/s12028-022-01653-6

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Citations (12)

Successful Extracorporeal Membrane Oxygenation Treatment in a Newly Diagnosed HIV Positive and Acquired Immune Defi-Ciency Syndrome (Aids) Patient with Acute Respiratory Distress Syndrome (Ards) Complicated by Pneumocystis and Cytomeg-Alovirus Pneumo

Jin Kook Kang Matthew Acton Bo Soo Kim

We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, Acquired Immune Deficiency Syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia present on presentation that was successfully managed with veno-venous extracorporeal membrane oxygenation (VV-ECMO). A 40-year-old female with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing where she was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Her pulmonary function quickly declined neces-sitating mechanical ventilation (MV). After she failed all conventional therapies, she was trans-ferred to a tertiary medical center for VV-ECMO therapy. Patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of her respiratory symptoms. She was discharged on hospital day 82. HIV positive patients with ARDS complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO.

Pneumocystis pneumonia

Cytomegalovirus

10.20944/preprints202408.0215.v1

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Contemporary Single-Center Experience with Axillary Intra-Aortic Balloon Pumps

The Journal of Heart and Lung Transplantation (2022)

Ana K. Velez Hannah Rando Matthew Acton Zachary Obinna Enumah Ahmet Kılıç

Intra-aortic balloon pump

Single Center

Axillary artery

10.1016/j.healun.2022.01.669

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Clinical Use of Bedside Portable Ultra–Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study

Circulation (2024)

Sung‐Min Cho Shivalika Khanduja Christopher Wilcox Kha Dinh Jiah Kim

BACKGROUND: Early detection of acute brain injury (ABI) at the bedside is critical in improving survival for patients with extracorporeal membrane oxygenation (ECMO) support. We aimed to examine the safety of ultra–low-field (ULF; 0.064-T) portable magnetic resonance imaging (pMRI) in patients undergoing ECMO and to investigate the ABI frequency and types with ULF-pMRI. METHODS: This was a multicenter prospective observational study (SAFE MRI ECMO study [Assessing the Safety and Feasibility of Bedside Portable Low-Field Brain Magnetic Resonance Imaging in Patients on ECMO]; NCT05469139) from 2 tertiary centers (Johns Hopkins, Baltimore, MD and University of Texas–Houston) with specially trained intensive care units. Primary outcomes were safety of ULF-pMRI during ECMO support, defined as completion of ULF-pMRI without significant adverse events. RESULTS: Of 53 eligible patients, 3 were not scanned because of a large head size that did not fit within the head coil. ULF-pMRI was performed in 50 patients (median age, 58 years; 52% male), with 34 patients (68%) on venoarterial ECMO and 16 patients (32%) on venovenous ECMO. Of 34 patients on venoarterial ECMO, 11 (22%) were centrally cannulated and 23 (46%) were peripherally cannulated. In venovenous ECMO, 9 (18%) had single-lumen cannulation and 7 (14%) had double-lumen cannulation. Of 50 patients, adverse events occurred in 3 patients (6%), with 2 minor adverse events (ECMO suction event; transient low ECMO flow) and one serious adverse event (intra-aortic balloon pump malfunction attributable to electrocardiographic artifacts). All images demonstrated discernible intracranial pathologies with good quality. ABI was observed in 22 patients (44%). Ischemic stroke (36%) was the most common type of ABI, followed by intracranial hemorrhage (6%) and hypoxic-ischemic brain injury (4%). Of 18 patients (36%) with both ULF-pMRI and head computed tomography within 24 hours, ABI was observed in 9 patients with a total of 10 events (8 ischemic, 2 hemorrhagic events). Of the 8 ischemic events, pMRI observed all 8, and head computed tomography observed only 4 events. For intracranial hemorrhage, pMRI observed only 1 of them, and head computed tomography observed both (2 events). CONCLUSIONS: Our study demonstrates that ULF-pMRI can be performed in patients on ECMO across different ECMO cannulation strategies in specially trained intensive care units. The incidence of ABI was high, seen in 44% of ULF-pMRI studies. ULF-pMRI imaging appears to be more sensitive to ABI, particularly ischemic stroke, compared with head computed tomography.

10.1161/circulationaha.124.069187

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Citations (3)

List of contributors: volume II

Elsevier eBooks (2023)

Ahmad Abutaka Matthew Acton Cara Agerstrand Akbarshakh Akhmerov İbrahim Akın

10.1016/b978-0-443-18918-0.00106-6

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