Neurocritical care and point‑of‑care MR imaging.
The challenges with conventional imaging in neurocritical care.
Fixed conventional MRI systems can be inconvenient and inaccessible for providers and patients, especially when time is critical. Providers must weigh the benefits of the information that imaging will provide against the risks of transport-related adverse events resulting from, for example, delayed treatment and disruption of therapy.
One of the most challenging aspects of transporting a patient is coordinating a team to manage the patient as they move from the ICU to the imaging department. Such a team typically includes a respiratory therapist, a physician or resident, and an ICU nurse familiar with the patient. Further exacerbating the situation, if the department is already short-staffed, taking an ICU nurse away to assist in imaging a patient could put other patients at risk.
Intrahospital transport of patients is associated with numerous cardiovascular and respiratory risks that may limit timely and safe neuroimaging for critically ill patients1. And unfortunately, even under the supervision of a well-trained transport team, adverse events may still occur in 20–70% of cases during transport to imaging2. Martin et al. reported that ventilator asynchrony was the most frequent adverse event and put patients at a higher risk for pneumothorax, atelectasis, and ventilator-associated pneumonia3. Beckman et al. reported difficulties with hardware, challenges with lifts to move the patient, issues with infusion lines, and a lack of battery life for equipment needed to support the patient4.
Swoop—the Hyperfine solution.
By bringing diagnostic MR imaging to the point of care, a Swoop® Portable MR Imaging System™ may contribute to reducing the length of stay (and associated costs) in the ICU by enabling clinical care teams with the potential to optimize staffing, shorten the time to diagnosis, potentially prevent adverse events related to transport, and reduce patient care interruptions. In addition to the many patient and clinician benefits, the Swoop system is more cost-effective to own and maintain than conventional high-field MRI systems. And, unlike high-field MRI, which requires specialized infrastructure and radiologic technicians to operate, Swoop system operation, navigation, and safety training is simple, which allows for expanded user access.
For the hospital, a Swoop system can help optimize staffing in the ICU by reducing the time required to coordinate clinical schedules and support staff for patient transport to radiology, allowing staff to remain where they’re needed most—in the ICU at the patient’s bedside or available to assist other patients. In addition to optimizing staff time, with a Swoop system in an ICU, results can be available three to seven hours earlier than those from conventional MRI5.
For the patient, the Swoop system reduces potential adverse events associated with patient transport and brings neuroimaging to the bedside of critically ill patients too unstable for transport to radiology. Patients can remain connected to all intravenous lines and most ICU monitoring equipment as long as it remains outside the controlled access area. The Swoop system is compliant with EMC emission standards and hospital ICUs and is not expected to affect most hospital equipment.
Additionally, a Swoop system enables clinicians to serially monitor a patient’s condition at the point of care, providing clinicians with real-time information to assist in critical care management decisions—without patient transport (and its associated risks) and without subjecting patients and staff to ionizing radiation from the portable CTs often used for serial follow-up scans.
In ICUs, a Swoop system images can help the clinician diagnose the following neurological conditions:
- Mass effect
- Midline shift
- Extra-axial CSF collection, as well as subdural and epidural hemorrhage
- Ventriculomegaly (ventricular enlargement) and often the etiology of hydrocephalus
- Bleeds (greater than 5mm)
- Non-contrast margins of gliomas
Swoop in Intensive Care Units
62-year-old female with prior history of breast carcinoma. Treated with local therapy and was in a normal state of good health until new-onset seizure. Due to the patient’s unstable condition while in the emergency department, the patient was imaged at the bedside using Swoop. Swoop images aided in diagnosing multiple intracranial metastatic lesions with surrounding mass effect and vasogenic edema.
35-year-old female with acute onset of severe headache associated with right-sided weakness. Due to labile blood pressure, the patient was imaged at the bedside using Swoop. Swoop images aided in diagnosing an intraparenchymal hemorrhage.
1. Sheth KN, Mazurek MH, Yuen MM, et al. Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA Neurol. 2021;78(1):41–47. doi:10.1001/jamaneurol.2020.3263
2. Mazurek MH, Cahn BA, Yuen MM, et al. Portable, bedside, low-field magnetic resonance imaging for evaluation of intracerebral hemorrhage. Nat Commun 2021;12:5119 doi: 10.1038/s41467-021-25441-6
3. Martin, M., Cook, F., Lobo, D., Vermersch, C., Attias, A., Ait- Mamar, B., Plaud, B., Mounier, R., & Dhonneur, G. (2016). Secondary Insults and Adverse Events During Intrahospital Transport of Severe Traumatic Brain-Injured Patients. Neurocritical Care, 26(1), 87–95. doi.org/10.1007/s12028-016-0291-5
4. Beckmann, U., Gillies, DonnaM., Berenholtz, SeanM., Wu, AlbertW., & Pronovost, P. (2004). Incidents relating to the intra-hospital transfer of critically ill patients. Intensive Care Medicine, 30(8). doi.org/10.1007/s00134-004-2177-9
5. Customer data on file at Hyperfine.