Clinical Trial Summary
Cerebral scans are a key examination in the management of serious brain-injured patients in
intensive care, and are often repeated in the initial phase. This is a critical clinical
period for these fragile patients, who are likely to develop episodes of intracranial
hypertension (ICHT), the duration of which is correlated with a poor prognosis. These
patients are therefore exposed to the complications of intra-hospital transport (IHT) (HTIC,
hypoxaemia, arterial hypotension, disconnection of the respirator, respiratory asynchronies),
which can worsen their vital and neurological prognosis. The incidence of adverse events
linked to HIT has been estimated at up to 79.8%, including episodes of HTIC, worsening the
prognosis and increasing the length of hospitalisation. In addition, patient safety during
HIT requires the mobilisation of a doctor, a nurse and a care assistant, an organisation that
implies a reduction in the care team's time with the other intensive care patients in their
care. In this context, the portable cranial scanner, with imaging quality similar to that of
conventional scanners, is already in routine use in the United States, the United Kingdom and
Germany. This tool could reduce examination times, thereby reducing the risk of adverse
events for the patient, in particular episodes of HTIC, and optimising the mobilisation of
intensive care professionals. Studies suggest that the use of portable cranial scanners
significantly reduces the duration of the examination (total duration including transport
time) (50 minutes for conventional scanners versus 20 minutes for portable scanners), without
altering the cerebral perfusion pressure or intracranial pressure of intensive care patients.
In addition, the use of portable scanners could generate savings for hospitals. In fact, in
American and British teams where the use of portable scanners is widespread, several studies
have shown that the time spent by radiology staff is reduced and the number of intensive care
professionals mobilised is reduced compared with the use of conventional scanners. In
addition, freeing up conventional scanner slots could lead to an increase in conventional
scanner activity. For example, in a neurovascular emergency department environment at
Massachusetts General Hospital, USA, the introduction of a mobile scanner reduced access time
to the examination by 58% (39 minutes ±5.1 vs. 17 ±2.7 for conventional scanning), which also
suggests faster implementation of emergency treatments such as the intravenous thrombolysis
evaluated in this study. Finally, an American study carried out in 2008 estimated the
financial gain generated by the use of a portable scanner versus a conventional scanner at
more than 2 million dollars over 5 years and a complete return on investment of 7 months,
from a hospital point of view.
To date, no French intensive care unit is using such a tool, even though the benefits appear
to be real in terms of reducing the number of episodes of hypertensive haemorrhage and the
prognostic impact this may have. The main aim of our pilot study is to assess the feasibility
of using a portable brain scanner in cerebro-injured patients in intensive care by comparing
the time taken to perform the portable examination with that of a conventional scanner. The
investigators will also evaluate the existence and duration of HTIC episodes and the
occurrence of any adverse events compared with a strategy based on a conventional fixed
scanner.
