R218Implementation of portable head-CT imaging for severely acute brain injured patients in a French ICU: a pilot observational study

Réanimation / Urgences
Technologie - Monitoring
Y. Launey 1, C. Mycinski 1, F. Eugene 1, J.C. Ferre 1, P. Seguin 1, J.Y. Gauvrit 1.
1Chu De Rennes - Rennes (France)

Conflits d'intérêt

Aucun


Position du problème et objectif(s) de l’étude

Head-CT-scanning is a cornerstone procedure during the management of patients admitted for acute brain injury (ABI) in intensive care unit (ICU). But, intrahospital transfer to imaging department to warrant these procedure may cause severe adverse events potentially worsening the brain injuries[1,2]. As previously reported, portable head-CT (pCTH) is a scanner used in several countries that may facilitate pCTH performance in safer conditions for the patients and enhance the cost-effectiveness ratio[3]. The objective of this study was to evaluate the feasibility and safety of pCTH in the French healthcare system for ICU patients admitted for ABI.


Matériel et méthodes

This was a prospective before-after study of patients admitted in ICU for severe ABI including traumatic brain injury, subarachnoid haemorrhage, intracranial haemorrhage or ischemic stroke from June 2019 to January 2021 in a university hospital. A written inform consent of patients or her/his relative were obtained as required by Research Ethics Board. The main primary endpoint was the time duration to perform pCTH compared to conventional head CT-scanner (cCTH). Collected data during CT-scanning periods including demographics and clinical characteristics, intracranial and arterial blood pressures patterns, ventilation parameters and adverse events occurrence were recorded and compared between the 2 periods. We estimated the cost of personal mobiliozed for CT-scanning over one year. Non-parametric tests were used for the statistical analyses.


Résultats & Discussion

Forty-five patients were included (25 in the pCTH group and 21 in the cCTH group). For reasons of device malfunction or monitoring failure, 22 patients were analysed in pCTH group and 20 in the cCTH group. The median (interquartile) time duration to perform pCTH was 29 (25-48) minutes compared to 30 (25-36) minutes in cCTH group, (p=0.91). A significant longer duration emerged for the first 8 pCTH procedures compared to the 12 following: 53 minutes (36-48) versus 25 minutes (18-28) respectively (p<0.01) No significant differences were observed in adverse events occurrence. A trend in higher ventilator mishaps was observed in cCTH group: 6 ventilator disconnections vs 1 in pCTH group. Similarly, vasopressors infusion doses were more frequently increased during cCTH compared to pCTH. No differences in ventilator-associated pneumonia or in-ICU mortality were observed in this study. The attempt to quantify the cost of staff mobilized during scanning assessed a gain of 2700 euros over 1 year. These results may only be applied to our ICU.


Conclusion

The pCTH seems feasible in ICU within the French healthcare system, displaying similar time of procedure and without increasing adverse events compared to cCTH. Short training period may be needed as the time duration of pCTH decreased over time. Financial cost savings might be significant when using such a device. Further larger studies in French ICUs are needed to confirm the results reported by North American healthcare system.


Références

1- Crit care Med; 2013, 41,8:1919-1928

2- Neurocrit Care; 2017, 26,1:87-95

3- Radiol Manage; 2008, 30,2:50-54


Remerciements

Special thanks to the department of Research and Innovation at the Rennes University Hospital for providing financial support to achieve renting of the Ceretom® medical scanner.

Thanks to Mrs Elise Bellec and Mr. Hubert Serpolay from the Radiation Protection unit, and the Department of Biomedical Engineering.