Case of cardiac arrest during MRI highlights importance of patient monitoring
A case report of a man who unexpectedly went into cardiac arrest during his MRI scan provides a stark reminder of the importance of monitoring patients throughout their exam.
Published in Cureus, the report details the case of a 65-year-old man with a history of diabetes and hypertension who was undergoing an MRI of his brainstem. He had just been admitted to the hospital due to symptoms indicative of acute ischemic stroke (dizziness, headache, nausea and deteriorating motor function). An initial MRI revealed he had occlusion of the right vertebral artery and acute ischemic changes in the brainstem, though his cerebral blood flow was deemed normal.
During his hospital stay, his symptoms began to worsen, prompting his care team to send him for an additional MRI six hours later. At that time, he was still able to move independently with some assistance.
The protocol included diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), T2-WI, T1-WI, MRA and T2-WI sequences. During the MRA portion of the scan, the tech observed a decrease in arterial blood flow signals, but assumed it was due to a technical malfunction. When the tech repeated the MRI sequence, the signals were still absent, prompting them to check on the patient.
In doing so, the tech realized the man was in cardiac arrest. They called for help and immediately initiated cardiopulmonary resuscitation, resulting in spontaneous circulation after around 10 minutes. During the episode, the patient had aspirated and developed hypoxic encephalopathy. His vitals eventually stabilized and he was sent to the intensive care unit, where he stayed for one month before being sent to a different facility.
It was estimated that the patient went into cardiac arrest around 10 minutes after his scan started. Although instances of cardiac arrest during MR imaging are rare, this case report highlights the importance of monitoring the vitals of patients at high risk of major cardiovascular events.
“In this case, the disappearance of arterial blood flow signals on MRA was observed but mistakenly attributed to a technical issue, delaying the recognition of cardiac arrest,” Hiroyuki Tokue, with the Department of Diagnostic Radiology and Nuclear Medicine at Gunma University in Japan, and co-authors explained. “As MRI can be time-consuming, especially in patients requiring prolonged scanning, real-time evaluation of images and interruption of scans when abnormalities are detected can improve patient outcomes.”
The authors suggested that continuous electrocardiogram and oxygen saturation monitoring should have been implemented during his scan considering his condition and prior imaging findings. They also emphasized the need to keep a watchful eye on patients' imaging in real-time as they are being scanned to monitor for abnormalities.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.