Clinical Application of Low-Field Magnetic Resonance Imaging in Patients on Extracorporeal Cardiopulmonary Resuscitation

Capital Medical University36 enrolled

Overview

Timely identification of acute brain injury (ABI) patterns in patients with extracorporeal cardiopulmonary resuscitation (ECPR) is essential for prognostic assessment and optimization of clinical management, particularly anticoagulation strategies. This study aimed to evaluate the safety and feasibility of early 0.23-T MRI examination in ECPR patients. The investigators further assessed the image quality of the 0.23-T MRI and investigated the incidence and patterns of ABI, as well as their associations with neurological outcomes. This prospective observational study was conducted in the emergency intensive care unit (EICU) of Beijing Chaoyang Hospital, a high-volume ECPR center. The primary outcome was the feasibility of performing 0.23-T MRI in patients undergoing ECPR, defined as successful completion of the examination without serious adverse events (AEs).

Study Type

OBSERVATIONAL

Enrollment

Conditions

Cardiac Arrest (CA)Extracorporeal Cardiopulmonary Resuscitation Acute Brain Injury

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Enrolled patients were those with out-of-hospital cardiac arrest of presumed cardiac cause, supported by ECPR, who achieved ROSC but remained unconscious and unable to obey verbal commands. Exclusion Criteria: * age \< 18 years * unwitnessed cardiac arrest * pregnancy * contraindications to MRI (except ECPR, for which safety with 0.23-T MRI has been proved) * physical dimensions exceeding scanner limits * refusal of consent by the family

Outcomes

Primary Outcomes

Feasibility of 0.23-T MRI examination

Defined as the percentage of participants who successfully complete the MRI examination without experiencing serious adverse events (AEs). AEs include a decrease in ECMO flow \> 10%, a change in mean arterial pressure of ± 20%, or a change in minute ventilation \> 20%.

Time frame: From the initiation of the MRI scan until 6 hours after its completion.

Secondary Outcomes

Image Quality

Assessment of the diagnostic quality of 0.23-T MRI images by board-certified neuroradiologists to evaluate noise, artifacts, and anatomical clarity.

Time frame: Within 6 hours after the completion of the MRI scan.

Incidence of Acute Brain Injury (ABI)

The proportion of patients identified with ABI patterns (such as ischemic stroke, intracranial hemorrhage, or cerebral edema) based on 0.23-T MRI findings.

Time frame: From the onset of cardiac arrest to the completion of the MRI scan

The association between ABI and neurological outcomes

Neurological outcomes were assessed at 3 months after ROSC using the Glasgow-Pittsburgh Cerebral Performance Category (CPC) scale. The CPC scale ranges from 1 to 5, with 1 indicating good performance, 2 indicating moderate disability, 3 indicating severe disability, 4 indicating vegetative state and 5 indicating brain death or death. The neurological outcomes were categorized as favorable prognosis (CPC 1-2) and poor prognosis (CPC 3-5).

Time frame: 3 months after ROSC.