University of Twente Student Theses
A digital twin for cardiac monitoring : In patients undergoing venoarterial extracorporeal membrane oxygenation
Azampanah, Kimmia (2024) A digital twin for cardiac monitoring : In patients undergoing venoarterial extracorporeal membrane oxygenation.
|
PDF
8MB |
| Abstract: | Introduction: Cardiogenic shock occurs in 5-10% of patients with acute myocardial infarction and is associated with high mortality rates of up to 60%. Patients with refractory cardiogenic shock can benefit from venoarterial extracorporeal membrane oxygenation (VA ECMO), which offers temporary circulatory mechanical support. Despite its benefits, VA ECMO carries significant risks. The optimal timing for weaning remains challenging due to the complexity of extracorporeal support, the interaction it has with the patient’s circulatory system and bedside monitoring, as well as a lack of evidence-based guidelines. This study therefore aims to develop a method for monitoring left ventricular contractile function in patients receiving VA ECMO support, using a digital twin to assist in daily clinical management and weaning of these patients. Methods: Relevant clinical parameters were collected from patients receiving VA ECMO in the ICU in the University Medical Centre Utrecht. The patient data were used to estimate model parameters and perform baseline tuning of the patient with an elaborate cardiovascular computational physiological model (CPM). A digital twin was modelled by further tuned the CPM using both automatic and manual protocols. Tuning was considered successful when all model output varied less than 10% from patient data. Cardiac contractile function was estimated by determining the end systolic elastance (Ees) and ventriculo-arterial coupling (VA coupling) in the digital twins. Results: Five patients were included in the study. The median RMSE of the automatically tuned digital twins was 0.181, with an interquartile range (IQR) of 0.151. The manual tuning protocol resulted in a median RMSE of 0.028 (IQR 0.0105). Discussion: The automatically tuned digital twins had a high RMSE, and the estimated cardiac function did not correlate well with the clinical outcomes of the patients. The manual tuning protocol demonstrated the feasibility of tuning a digital twin with the cardiovascular CPM. The estimated cardiac function of manually tuned digital twins also correlated better with clinical outcomes,discrepancies still existed in several cases. With improvement and rigorous validation, a digital twin could ultimately become a clinical decision-making tool to support daily management and weaning strategies for patients on VA ECMO. |
| Item Type: | Essay (Master) |
| Clients: | University Medical Centre Utrecht, Utrecht, Nederland |
| Faculty: | TNW: Science and Technology |
| Subject: | 44 medicine, 50 technical science in general |
| Programme: | Technical Medicine MSc (60033) |
| Link to this item: | https://purl.utwente.nl/essays/100627 |
| Export this item as: | BibTeX EndNote HTML Citation Reference Manager |
Show download statistics for this publication
Show download statistics for this publicationRepository Staff Only: item control page