Mobile MRI: Gates Foundation funds world's first examinations in children under ECMO

The University Hospital of Bonn (UKB) is the first hospital in the world to examine and monitor children receiving ECMO therapy with a mobile magnetic resonance imaging (MRI) scanner. This was possible thanks to a funding from the Bill & Melinda Gates Foundation.

In an interview with MEDICA-tradefair.com, Prof. Hemmen Sabir explains why the use of the mobile MRI is of such importance for the small ECMO patients.

Prof. Sabir: What is ECMO therapy?

Prof. Hemmen Sabir: ECMO - extracorporeal membrane oxygenation - involves oxygenating the blood outside the body. It is a procedure for patients who need an artificial lung and/or heart. There are two forms of ECMO. One is the form that supports the heart and lungs, and the other is the form that supports the lungs, which we use here at UKB Bonn in neonatology.

Children who need this procedure can only be treated at a special treatment center such as our Children's ECMO Center, where they are closely monitored. We are leaders in this field and treat both newborns and older children.

Why do your young patients need ECMO?

Sabir: They are all seriously ill, suffering from lung failure, heart failure, severe general infections or a hole in the diaphragm, for example. They can't be helped by drug support and a conservative ventilator alone.

How should ECMO be envisioned in such young patients?

Sabir: Blood from the body is delivered through a cannula in a vein to the ECMO machine, where it is oxygenated. After oxygenation, the blood is returned to the body through a second cannula.

While adults have a tube inserted in the groin area to transport the blood during ECMO therapy, children often have access at the neck. Patients must be moved very carefully so that the tube at the neck is moved only minimally. The children are sedated, so that they sleep peacefully and do not experience pain.

What makes the mobile MRI examination during ECMO so significant?

Sabir: ECMO generally has a certain complication rate. For example, in order for blood to flow out of the body through the plastic tubes, it must be thinned. That puts our sensitive patients at risk for brain hemorrhages or strokes.

Until now, we have not been able to monitor them adequately during ECMO, and, above all, we have not had any form of imaging that would allow us to make a reliable diagnosis, for example, of brain hemorrhages. That's because we can't take the children on ECMO to MRI, reposition them multiple times, and we don't want to expose them to the radiation of a CT scan. That would be too risky.

So, if they suffer a brain hemorrhage, we may catch it too late. Having an imaging option on the ward now with the mobile MRI is a revolution in neuro-monitoring.

But is the idea of a mobile MRI on a ward new?

Sabir: No, the idea is not new. But using it in an intensive care setting was previously impossible because of the magnetic fields. Hyperfine's new mobile MRI generates only a minimal magnetic field and thus does not interfere with other equipment. It has already been approved in the U.S. and we have been able to clinically test it for the first time in the world for six months in the diagnosis of premature and newborn infants thanks to funding from the Bill Gates Foundation, which purchased 20 of the units.

It was primarily developed for rapid imaging of stroke patients in remote regions. So far, only one other device outside of Bonn is being used for research purposes in London.

How many children have you been able to examine?

Sabir: Since we have had the device, we have scanned over 25 children in the mobile MRI. The youngest weighed only 450 grams, and the oldest was already ten years old. We have used the mobile MRI during routine examinations and for further diagnosis of abnormalities, for example, after oxygen deficiency at birth.

To evaluate the image quality of the mobile low-field MRI, a comparison image was made in the stationary normal-field MRI for each of the children examined. We were more than satisfied with the results. Although the image quality of the mobile MRI is not as high-resolution as that of a fixed device, the image data are ideal for emergency diagnostics and, above all, can be retrieved immediately. We have been able to detect brain hemorrhages, strokes, or changes such as cerebrospinal fluid buildup in the children examined to date and initiate the appropriate therapies immediately.

In addition, we were able to demonstrate in four pediatric ECMO patients - a newborn, a two-year-old, a nine-year-old, and a ten-year-old - that imaging using mobile MRI can be easily performed without changing the position of the neck cannula. In one of the children, we were able to diagnose a major brain hemorrhage and treat it immediately.

The use of mobile MRI can be implemented with so little effort, it's a revolution and a huge relief for everyone - the children, their parents, our nursing staff, and us physicians.

Everything that interests me as an intensive care physician in an acute situation, such as whether there is a hemorrhage or whether cerebrospinal fluid has accumulated, can be excellently answered immediately with the mobile MRI in patients for whom another form of imaging would not be feasible.

Where do you see the future of mobile MRI?

Sabir: Theoretically, it could be in every family doctor's office. It doesn't take up much space and doesn't consume more electricity than a coffee machine.