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Extracorporeal Membrane Oxygenation ComplicationSAFE MRINCT05469139

Assessing Brain Injury Using Portable Magnetic Resonance Imaging (MRI)

An observational study of Extracorporeal Membrane Oxygenation Complication and Acute Brain Injury, run by Johns Hopkins University at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study aims to assess the feasibility of assessing acute brain injury using a portable low field MRI in patients on ECMO. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Portable MRI acquisition
How many people
50 participants
Where
2 sitesUnited States
Study dates
10 Dec 2021to 11 Mar 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Adults patients on extracorporeal membrane oxygenation support (ECMO)

Who may be able to join

  • Adults age 18 and over
  • Patient supported with extracorporeal membrane oxygenation support (ECMO)
  • Legally authorized representative has provided written informed consent

Who cannot join

  • Patient has a contraindication for MRI such as:
  • Implants such as pacemaker, defibrillator, implanted insulin pump, deep brain stimulator, vagus nerve stimulator, cochlear implant, or programmable shunt
  • MRI incompatible surgical hardware such as staples, screws. ferromagnetic implants such as aneurysm clips, surgical clips, prostheses, cochlear implant
  • artificial hearts or heart valves with steel parts
  • metal fragments
  • shrapnel
Show all 13Show fewer
  • tattoos near the eye
  • permanent make-up
  • steel implants
  • or other irremovable ferromagnetic objects
  • Patient weight is over 440 lbs (or 200kg)
  • Patient has Intra Aortic Balloon Pump (IABP), Implanted Ventricular Assist Device (VAD), or Percutaneous Ventricular Assist Device
  • Patient is pregnant

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Johns Hopkins Hospital

    Baltimore, Maryland, 21287

  • University of Texas Health Science Center

    Houston, Texas, 77030

Other trials in United States

About this study

Official title: Assessing Brain Injury Using Portable Magnetic Resonance Imaging in Patients With Extracorporeal Membrane Oxygenation

This study aims to assess the feasibility of assessing acute brain injury using a portable low field MRI in patients on ECMO.

Read the detailed description

Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy increasingly used in patients with refractory cardiopulmonary failure. The Extracorporeal Life Support Organization (ELSO) registry recently reported a 58% survival rate among patients who receive ECMO support, showing a significant mortality benefit in patients who would have not survived without ECMO. However, acute brain injury (ABI) is common in patients with ECMO support and leads to devastating consequences with significant morbidity and mortality. The mortality increases more than two-fold when ABI is present for both venoarterial (VA) and venovenous (VV) ECMO patients. The poor prognosis of ABI and neurological complications would suggest potential benefit from stringent and possibly even protocolized neurological monitoring to prevent or minimize further harm. This is particularly important as recent evidence promotes extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue therapy for patients suffering from cardiac arrest of potentially reversible etiology. As clinical experience accumulates and ECPR becomes more widely used, neurological monitoring for complications and prognostication will be imperative for optimizing patient outcomes.

Although standardized neurological monitoring improves the detection of ABI, timely diagnosis and management for ABI in patients with ECMO support is still challenging due to the difficulty, impracticality, and danger of transporting ECMO patients to a CT scanner. Often, ECMO patients are unable to be transported to radiology suites because of the patients' persistent cardiopulmonary instability with multiple vasopressor requirements. In addition, even if head CT is performed in these patients, it is limited by poor sensitivity for detecting acute ischemic brain injury. Early neuroimaging is a key neuromonitoring aspect in the clinical evaluation of ABI. However, conventional magnetic resonance imaging (MRI) systems operate at high magnetic field strengths (1.5-3T) that require strict, access-controlled environments. Thus, limited access to timely brain scan with images of sufficient quality remains a significant barrier to effectively monitoring the occurrence and progression of ABI in ECMO.

Recent advances in low-field and portable MRI technology have enabled the acquisition of clinically meaningful imaging in the presence of ferromagnetic materials. A very low magnetic field strength, 64 magnetization transfer (mT), approximately 1/23 the field strength of a conventional MRI) provides a 5 Gauss line (safety zone) that is only about 2.5 feet from the center of the scanner. In a previous report, researchers were able to demonstrate the feasibility of a low-field, portable MRI in complex clinical care settings, such as intensive care units, without any adverse events or complications. In addition to reduced projectile motion, the use of low-field MRI may mitigate other safety concerns associated with high-field MRI, such as peripheral nerve stimulation (from gradients), a radiofrequency absorption and heating and acoustic noise.

The objective of this study is to assess acute brain injury with low-field, portable MRI of brain in patients with ECMO support.

This study will use the Hyperfine portable MRI machine which has FDA 510(k) clearance and is intended for use in intensive care units. The investigators' hypothesis is that low-field, portable MRI can detect ABI in patients with ECMO support, which may decrease the morbidity of patients on ECMO.

Being tested
Portable MRI acquisition
Medical subject headings
Brain Injuries

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Portable MRI acquisitionDiagnostic test

    Patients on ECMO will undergo a portable MRI of the brain

Study groups in NCT05469139
Study groupRoleWhat they receive
Portable MRI groupPatients on ECMO who undergo portable MRI to assess brain injury within 24-48 hours of ECMO initiation
Receives: Diagnostic Test: Portable MRI acquisition

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Acute brain injury as assessed by head CT scan

    compare results of routinely performed head CT scans with results from a low field MRI to determine whether acute brain injury can be assessed using a low field MRI in patients with ECMO support.

    Measured: 48 hours from ECMO initiation

Secondary outcomes (4)
  1. prevalence of early acute brain injury as assessed by MRI scan

    use interpretations of low field MRI scans to determine the prevalence of early acute brain injury of patients with ECMO support at 24 hours

    Measured: 24 hours from ECMO initiation

  2. Image Quality

    compare image quality of low field MRI scans with the image quality of routinely performed head CT scans to assess the image quality of MR images for infarcts and hemorrhages

    Measured: 48 hours from ECMO initiation

  3. Impact of early detection as assessed by MRI

    assess anticoagulation strategies following low field MRI to determine the impact of early detection of acute brain injury on anticoagulation strategy

    Measured: 48 hours from ECMO initiation

  4. Association of Transcranial doppler ultrasound with ischemic infarct

    measure transcranial doppler ultrasounds and correlate the findings with the results of low field MRI to assess for an association between Transcranial doppler ultrasound (TCD) microembolic signal (MES) and the presence of ischemic infarct on MRI.

    Measured: 48 hours from ECMO initiation

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Jul 2022
  2. Study start10 Dec 2021
  3. Primary completion30 Nov 2023
  4. Study completion11 Mar 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05469139
Sponsor's protocol ID
IRB00285716
Acronym
SAFE MRI
Status last verified
Mar 2024
First submitted
19 Jul 2022
Last updated
13 Mar 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No: Clinical Study report will be available upon completion of the study analysis

Publications

  • McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, Szeto WY, Bermudez CA, Atluri P, Acker MA, Desai ND. Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002-2012. Semin Thorac Cardiovasc Surg. 2015 Summer;27(2):81-8. doi: 10.1053/j.semtcvs.2015.07.005. Epub 2015 Jul 22.

    PubMed 26686427
  • Thiagarajan RR, Barbaro RP, Rycus PT, Mcmullan DM, Conrad SA, Fortenberry JD, Paden ML; ELSO member centers. Extracorporeal Life Support Organization Registry International Report 2016. ASAIO J. 2017 Jan/Feb;63(1):60-67. doi: 10.1097/MAT.0000000000000475.

    PubMed 27984321
  • Cho SM, Canner J, Caturegli G, Choi CW, Etchill E, Giuliano K, Chiarini G, Calligy K, Rycus P, Lorusso R, Kim BS, Sussman M, Suarez JI, Geocadin R, Bush EL, Ziai W, Whitman G. Risk Factors of Ischemic and Hemorrhagic Strokes During Venovenous Extracorporeal Membrane Oxygenation: Analysis of Data From the Extracorporeal Life Support Organization Registry. Crit Care Med. 2021 Jan 1;49(1):91-101. doi: 10.1097/CCM.0000000000004707.

    PubMed 33148951
  • Cho SM, Canner J, Chiarini G, Calligy K, Caturegli G, Rycus P, Barbaro RP, Tonna J, Lorusso R, Kilic A, Choi CW, Ziai W, Geocadin R, Whitman G. Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry. Crit Care Med. 2020 Oct;48(10):e897-e905. doi: 10.1097/CCM.0000000000004498.

    PubMed 32931195
  • Brooks SC, Anderson ML, Bruder E, Daya MR, Gaffney A, Otto CW, Singer AJ, Thiagarajan RR, Travers AH. Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S436-43. doi: 10.1161/CIR.0000000000000260. No abstract available.

    PubMed 26472994
  • Cho SM, Ziai W, Mayasi Y, Gusdon AM, Creed J, Sharrock M, Stephens RS, Choi CW, Ritzl EK, Suarez J, Whitman G, Geocadin RG. Noninvasive Neurological Monitoring in Extracorporeal Membrane Oxygenation. ASAIO J. 2020 Apr;66(4):388-393. doi: 10.1097/MAT.0000000000001013.

    PubMed 31045914
  • Sheth KN, Mazurek MH, Yuen MM, Cahn BA, Shah JT, Ward A, Kim JA, Gilmore EJ, Falcone GJ, Petersen N, Gobeske KT, Kaddouh F, Hwang DY, Schindler J, Sansing L, Matouk C, Rothberg J, Sze G, Siner J, Rosen MS, Spudich S, Kimberly WT. Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA Neurol. 2020 Sep 8;78(1):41-7. doi: 10.1001/jamaneurol.2020.3263. Online ahead of print.

    PubMed 32897296
  • Campbell-Washburn AE, Ramasawmy R, Restivo MC, Bhattacharya I, Basar B, Herzka DA, Hansen MS, Rogers T, Bandettini WP, McGuirt DR, Mancini C, Grodzki D, Schneider R, Majeed W, Bhat H, Xue H, Moss J, Malayeri AA, Jones EC, Koretsky AP, Kellman P, Chen MY, Lederman RJ, Balaban RS. Opportunities in Interventional and Diagnostic Imaging by Using High-Performance Low-Field-Strength MRI. Radiology. 2019 Nov;293(2):384-393. doi: 10.1148/radiol.2019190452. Epub 2019 Oct 1.

    PubMed 31573398
  • Formica D, Silvestri S. Biological effects of exposure to magnetic resonance imaging: an overview. Biomed Eng Online. 2004 Apr 22;3:11. doi: 10.1186/1475-925X-3-11.

    PubMed 15104797
  • Hartwig V, Giovannetti G, Vanello N, Lombardi M, Landini L, Simi S. Biological effects and safety in magnetic resonance imaging: a review. Int J Environ Res Public Health. 2009 Jun;6(6):1778-98. doi: 10.3390/ijerph6061778. Epub 2009 Jun 10.

    PubMed 19578460
  • Shellock FG, Crues JV. Aneurysm clips: assessment of magnetic field interaction associated with a 0.2-T extremity MR system. Radiology. 1998 Aug;208(2):407-9. doi: 10.1148/radiology.208.2.9680568.

    PubMed 9680568
  • Alorainy IA, Albadr FB, Abujamea AH. Attitude towards MRI safety during pregnancy. Ann Saudi Med. 2006 Jul-Aug;26(4):306-9. doi: 10.5144/0256-4947.2006.306. No abstract available.

    PubMed 16885635

Questions about this trial

What is this clinical trial studying?

An observational study of Extracorporeal Membrane Oxygenation Complication and Acute Brain Injury, run by Johns Hopkins University at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Acute brain injury as assessed by head CT scan (time frame: 48 hours from ECMO initiation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05469139, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Mar 2024.

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