A pediatric transcarotid arteriovenous ECMO cannula depth prediction method and system
By establishing a formula for predicting the insertion depth of pediatric transjugular artery and vein ECMO, the problem of improper insertion position was solved, the success rate and safety of insertion were improved, complications were reduced, and a reference for standardized operation was provided.
Patent Information
- Application Number
- CN202511462111.9
- Authority / Receiving Office
- CN · China
- Patent Type
- Patents(China)
- Current Assignee / Owner
- Filing Date
- 2025-10-14
- Publication Date
- 2026-02-10
- Estimated Expiration
- 2045-10-14
AI Technical Summary
Current technology lacks guidance on the optimal cannulation position for transcarotid artery and vein ECMO in children, leading to improper cannulation placement, complications, increased morbidity and mortality, and frequent adjustments increase the risk of vascular injury and infection.
By collecting pediatric cardiac CTA examination data, a formula for predicting intubation depth was established. Using linear regression analysis of body weight and intubation depth, a reference for intubation depth was provided. The prediction formulas for arterial and venous intubation depth are: =0.109x + 2.679 and =0.325x + 5.157, which helps doctors estimate the intubation depth more accurately before intubation.
It has improved the success rate and safety of ECMO intubation, reduced complications caused by improper intubation location, provided a reference for standardized operation, and filled the gap in intubation prediction.
Smart Images
Figure CN120918789B_ABST
Abstract
Description
TECHNICAL FIELD
[0001] The present application relates to the technical field of data processing, in particular to a pediatric jugular artery-vein ECMO cannula depth prediction method and system. BACKGROUND
[0002] In 1972, Hill et al. first reported the use of ECMO to rescue adult patients with acute respiratory failure. Subsequently, the Bartlett team reported in 1976 that ECMO was used to treat infantile cardiopulmonary failure. In the past decade, with the continuous expansion of the clinical application of ECMO and the rapid updating of ECMO equipment, this technology has become an important means to rescue children with cardiopulmonary failure. ECMO is a cardiopulmonary support method developed from extracorporeal circulation technology. This technology is widely used in children with cardiopulmonary failure caused by various reasons, including severe pneumonia, acute respiratory distress syndrome, fulminant myocarditis, and perioperative period of heart malformation. According to the statistics of the International Extracorporeal Life Support Organization (ELSO), at present, the vast majority of ECMO treatment cases are children. According to the type of blood drainage and return blood vessels, ECMO has two treatment modes: V-A ECMO, which draws from the venous system and injects into the arterial branch; V-V ECMO, which draws from the vein and injects into the vein. V-V ECMO is mainly used for respiratory failure patients with preserved heart function. V-A ECMO is more widely used because it can provide respiratory support and heart function support at the same time.
[0003] Because the femoral artery-vein diameter of children (especially children weighing less than 30 kg) is small, it cannot meet the demand of ECMO operating flow, so ECMO cannula usually needs to use jugular artery-vein cannula. Pediatric jugular artery-vein cannulation for ECMO is full of technical challenges. Among them, the best position of artery-vein cannulation is crucial for ECMO flow and ECMO operation. Due to the small heart size of children and the challenging anatomical structure, especially in neonates, it is particularly difficult to place the artery-vein cannula at the best position at one time. Misplacement of ECMO cannula can cause an increase in the incidence of complications and mortality. Improper placement of venous cannula can cause serious complications such as atrial perforation with cardiac tamponade, arrhythmia, or insufficient venous drainage leading to ECMO pump stoppage. Improper placement of arterial cannula can cause aortic valve regurgitation, increased cardiac afterload, and ECMO machine pump pressure. Frequent adjustment of cannula position can easily cause vascular injury and increase the risk of bleeding and infection. However, at present, there is no guideline or consensus to give recommendations on the depth of pediatric jugular artery-vein ECMO cannula. Therefore, in order to fill this gap, the present application proposes a pediatric jugular artery-vein ECMO cannula depth prediction method and system that can provide a reference for pediatric jugular artery-vein ECMO cannulation. SUMMARY
[0004] The technical problem to be solved by the present application is to provide a pediatric transcarotid arterial and venous ECMO cannula depth prediction method and system which can provide a reference for pediatric transcarotid arterial and venous ECMO cannula.
[0005] To solve the above technical problems, the technical scheme adopted by the present application is:
[0006] A pediatric transcarotid arterial and venous ECMO cannula depth prediction method comprises:
[0007] Collect data, select congenital heart disease children who have undergone heart CTA examination or multiple children who have undergone transcarotid arterial and venous cannula ECMO treatment as data objects, and each child weighs < 30 kg; determine the cannula depth according to the CTA image of the child, and the cannula depth takes the incision position as the starting point; the incision position positioning method comprises: the ECMO incision of an infant less than 6 months old is 1 cm above the right neck clavicle, the ECMO incision of a child aged 6 months to 2 years old is 1.5 cm above the right neck clavicle, and the ECMO incision of a child older than 2 years old is 2 cm above the right neck clavicle; according to the corresponding incision position, measure the depth of the common carotid artery to the aortic arch at the entrance of the innominate artery at the corresponding incision position as the ECMO arterial cannula depth ; according to the corresponding incision position, measure the depth of the internal jugular vein to the inferior vena cava at the entrance of the right atrium at the corresponding incision position as the ECMO venous cannula depth ;
[0008] Establish a prediction formula, establish a coordinate system, the x-axis of the coordinate system is the weight, and the y-axis is the cannula depth; the weight x of the child, the arterial cannula depth , and the venous cannula depth are embodied in the coordinate system using (x, ), (x, ), and statistical analysis is applied to calculate the arterial cannula prediction formula as: = 0.109x + 2.679, and the venous cannula prediction formula as: = 0.325x + 5.157;
[0009] Output the prediction result, input the information of the prediction object, the prediction object is a new child, input the age of the new child to determine the incision position, and the incision position positioning method is adopted; input the weight x of the new child into the arterial cannula prediction formula and the venous cannula prediction formula, and output the predicted arterial cannula depth and the predicted venous cannula depth for reference.
[0010] Preferably, paired t-test is performed on the output predicted arterial cannula depth and the actual arterial cannula depth of the new child; and paired t-test is performed on the output predicted venous cannula depth and the actual venous cannula depth of the new child.
[0011] Preferably, if the CTA examination is not clear and / or the clinical data of the child is incomplete, the data of the child is excluded.
[0012] Preferably, the statistical analysis is performed by using SPSS 25.0 software.
[0013] Preferably, the statistical analysis is linear regression analysis.
[0014] To solve the above technical problems, another technical solution adopted by the present application is:
[0015] A pediatric transjugular ECMO cannula depth prediction system, comprising:
[0016] A data module, congenital heart disease children who have undergone heart CTA examination or multiple children who have undergone transjugular cannula ECMO treatment are selected as data objects, and each child weighs < 30 kg; the cannula depth is determined according to the CTA image of the child, and the cannula depth takes the incision position as the starting point; the incision position positioning method comprises: the ECMO incision of an infant less than 6 months old is 1 cm above the right neck clavicle, the ECMO incision of a child aged 6 months to 2 years old is 1.5 cm above the right neck clavicle, and the ECMO incision of a child older than 2 years old is 2 cm above the right neck clavicle; according to the corresponding incision position, the depth of the common carotid artery to the aortic arch at the entrance of the innominate artery at the corresponding incision position is measured as the ECMO arterial cannula depth ; according to the corresponding incision position, the depth of the internal jugular vein to the inferior vena cava at the entrance of the right atrium at the corresponding incision position is measured as the ECMO venous cannula depth ;
[0017] A prediction module, a coordinate system is established, the x-axis of the coordinate system is the weight, and the y-axis is the cannula depth; the weight x of the child, the arterial cannula depth , and the venous cannula depth are embodied in the coordinate system using (x, ), (x, ), and statistical analysis is applied to calculate the arterial cannula prediction formula as: = 0.109x + 2.679, and the venous cannula prediction formula as: = 0.325x + 5.157.
[0018] An output module, information of a prediction object is input, the prediction object is a new child, the age of the new child is input to determine the incision position, the incision position positioning method is used to determine the incision position; the weight x of the new child is input to the arterial cannula prediction formula and the venous cannula prediction formula, and the predicted arterial cannula depth and the predicted venous cannula depth are output for reference.
[0019] Preferably, paired t-test is performed on the output predicted arterial cannulation depth and the actual arterial cannulation depth of the new patient; paired t-test is performed on the output predicted venous cannulation depth and the actual venous cannulation depth of the new patient.
[0020] Preferably, the data of the patient is excluded if the CTA examination is unclear and / or the clinical data of the patient is incomplete.
[0021] Preferably, the statistical analysis is performed by using SPSS 25.0 software.
[0022] Preferably, the statistical analysis is linear regression analysis.
[0023] The present application has the beneficial effects that: by summarizing the existing experience of pediatric transcarotid arterial and venous cannulation for ECMO, the prediction formula of the transcarotid arterial and venous cannulation depth for ECMO is calculated and verified, so as to provide a reference for pediatric transcarotid arterial and venous cannulation for ECMO, which can help doctors to more accurately estimate the cannulation depth before cannulation, and reduce the complications caused by improper cannulation position; the prediction formula can be used as part of the standardized operation, so as to improve the success rate and safety of ECMO cannulation; and the blank of arterial and venous cannulation prediction for ECMO is filled. BRIEF DESCRIPTION OF DRAWINGS
[0024] Fig. 1 The coordinate system and the prediction formula calculated by the statistical analysis of the application embodiment of the pediatric transcarotid arterial and venous cannulation depth prediction method for ECMO;
[0025] Fig. 2 The actual arterial cannulation depth and the predicted arterial cannulation depth of the application embodiment of the pediatric transcarotid arterial and venous cannulation depth prediction method for ECMO are compared in the schematic view;
[0026] Fig. 3 The actual venous cannulation depth and the predicted venous cannulation depth of the application embodiment of the pediatric transcarotid arterial and venous cannulation depth prediction method for ECMO are compared in the schematic view; DETAILED DESCRIPTION
[0027] In order to explain the technical content, the purposes and effects of the present application in detail, the following will be described in combination with the embodiments and the accompanying drawings.
[0028] Please refer to Figs. 1-3 A pediatric transcarotid arterial and venous cannulation depth prediction method for ECMO, comprising:
[0029] Collect data, select congenital heart disease children who undergo heart CTA examination (carotid artery CT angiography) or multiple children who undergo jugular vein cannulation ECMO treatment as data objects, and each child weighs < 30 kg; determine the cannulation depth according to the CTA image of the child, and the cannulation depth is taken as the starting point of the incision position; the incision position positioning method includes: the ECMO incision of infants less than 6 months old is 1 cm above the right side of the neck clavicle, the ECMO incision of children aged 6 months to 2 years old is 1.5 cm above the right side of the neck clavicle, and the ECMO incision of children older than 2 years old is 2 cm above the right side of the neck clavicle; according to the corresponding incision position, the depth of the common carotid artery to the aortic arch at the innominate artery is measured as the ECMO arterial cannulation depth ; according to the corresponding incision position, the depth of the internal jugular vein to the inferior vena cava into the right atrium at the corresponding incision position is measured as the ECMO venous cannulation depth ;
[0030] Establish a prediction formula, establish a coordinate system, and the x-axis of the coordinate system is the weight, and the y-axis is the cannulation depth; the weight x of the child, the arterial cannulation depth , and the venous cannulation depth are embodied in the coordinate system using (x, ), (x, ), and statistical analysis is applied to calculate the arterial cannulation prediction formula as: = 0.109x + 2.679, and the venous cannulation prediction formula as: = 0.325x + 5.157;
[0031] Output the prediction result, input the information of the prediction object, and the prediction object is a new child; input the age of the new child to determine the incision position, and the incision position positioning method is used; input the weight x of the new child into the arterial cannulation prediction formula and the venous cannulation prediction formula, and output the predicted arterial cannulation depth and the predicted venous cannulation depth for reference.
[0032] As can be seen from the above description, by summarizing the existing pediatric jugular vein ECMO cannulation experience, the prediction formula of the jugular vein ECMO cannulation depth is calculated and verified, so as to provide a reference for pediatric jugular vein ECMO cannulation, help doctors more accurately estimate the cannulation depth before cannulation, and reduce complications caused by improper cannulation position; the prediction formula can be used as part of the standardized operation to improve the success rate and safety of ECMO cannulation; fill the gap of dynamic vein ECMO cannulation prediction.
[0033] Further, paired t-test is performed on the output predicted arterial cannulation depth and the actual arterial cannulation depth of the new child; and paired t-test is performed on the output predicted venous cannulation depth and the actual venous cannulation depth of the new child.
[0034] From the above description, the prediction effect can be tested by paired t-test.
[0035] Further, if the CTA examination is not clear and / or the clinical data of the child is incomplete, the child's data is excluded.
[0036] Further, the statistical analysis is performed using SPSS 25.0 software.
[0037] Further, the statistical analysis is linear regression analysis.
[0038] A pediatric transcarotid artery and vein ECMO cannula depth prediction system, comprising:
[0039] A data module, congenital heart disease children who have undergone heart CTA examination or multiple children who have undergone transcarotid artery and vein cannula ECMO treatment are selected as data objects, and each child weighs <30 kg; The cannula depth is determined according to the CTA image of the child, and the cannula depth takes the incision position as the starting point; The incision position positioning method includes: the ECMO incision of infants less than 6 months old is 1 cm above the right neck clavicle, the ECMO incision of children aged 6 months to 2 years old is 1.5 cm above the right neck clavicle, and the ECMO incision of children older than 2 years old is 2 cm above the right neck clavicle; According to the corresponding incision position, the depth of the common carotid artery to the aortic arch at the innominate artery is measured as the ECMO arterial cannula depth ; According to the corresponding incision position, the depth of the internal jugular vein to the inferior vena cava into the right atrium at the corresponding incision position is measured as the ECMO venous cannula depth ;
[0040] A prediction module, a coordinate system is established, the x-axis of the coordinate system is the weight, and the y-axis is the cannula depth; The weight x of the child, the arterial cannula depth , and the venous cannula depth are embodied in the coordinate system using (x, ), (x, ), and statistical analysis is applied to calculate the arterial cannula prediction formula as: = 0.109x + 2.679, and the venous cannula prediction formula as: = 0.325x + 5.157;
[0041] An output module, information of a prediction object is input, the prediction object is a new child, the age of the new child is input to determine the incision position, the incision position positioning method is used to determine the incision position; The weight x of the new child is input to the arterial cannula prediction formula and the venous cannula prediction formula, and the predicted arterial cannula depth and the predicted venous cannula depth are output for reference.
[0042] Further, paired t test was performed on the output predicted arterial cannulation depth and the actual arterial cannulation depth of the new sick children; paired t test was performed on the output predicted venous cannulation depth and the actual venous cannulation depth of the new sick children.
[0043] Further, if the CTA examination is not clear and / or the clinical data of the sick children is incomplete, the data of the sick children is excluded.
[0044] Further, statistical analysis is performed by using SPSS 25.0 software.
[0045] Further, the statistical analysis is linear regression analysis.
[0046] Embodiment
[0047] A pediatric transcarotid arterial and venous cannulation depth prediction method, comprising:
[0048] In this study, the CTA examination data of 353 cases of congenital heart disease children (data objects) who underwent surgical treatment in Fujian Children's Hospital from January 2022 to December 2023 were collected, and the prediction formula was calculated. The data of 44 new sick children (prediction objects) who underwent transcarotid cannulation ECMO treatment in our hospital from January 2021 to February 2024 were collected to verify the accuracy of the prediction formula.
[0049] The inclusion criteria for data objects and prediction objects are: 1. Congenital heart disease children who underwent CTA examination or children who underwent transcarotid cannulation ECMO treatment; 2. Body weight < 30 kg. The exclusion criteria for data objects and prediction objects are: 1. CTA image is not clear 2. The clinical data of the sick children is incomplete.
[0050] According to the CTA image of the sick children, the cannulation depth is determined, and the cannulation depth is taken as the starting point of the incision position; the incision position positioning method includes: for infants less than 6 months old, the ECMO incision is 1 cm above the right side of the clavicle; for children aged 6 months to 2 years old, the ECMO incision is 1.5 cm above the right side of the clavicle; for children over 2 years old, the ECMO incision is 2 cm above the right side of the clavicle; according to the corresponding incision position, the depth of the common carotid artery to the innominate artery into the aortic arch at the corresponding incision position is measured as the ECMO arterial cannulation depth ; according to the corresponding incision position, the depth of the internal jugular vein to the inferior vena cava into the right atrium at the corresponding incision position is measured as the ECMO venous cannulation depth .
[0051] Statistical analysis was performed using SPSS 25.0. Continuous variables with normal distribution deviation were expressed as mean ± standard deviation, and those without normal distribution deviation were expressed as median and quartile. Linear regression analysis was used to calculate the ECMO arterial and venous cannula depth prediction formula. Paired t test was used to compare the actual and predicted cannula depth of ECMO treated children. p <0.05 was considered statistically significant.
[0052] Reference Fig. 1 A total of 353 children with congenital heart disease who underwent CTA were included in this study. The CTA image measurement results were used to calculate the ECMO arterial and venous cannula depth prediction formula. The average age of these children was 13.9 months, and the average weight was 7.9 kg. The ideal arterial cannula depth was 3.5 ± 0.6 cm, and the ideal venous cannula depth was 7.7 ± 1.7 cm. Linear regression analysis was used to calculate the arterial cannula prediction formula: = 0.109x + 2.679 = 0.7113); and the venous cannula prediction formula: = 0.325x + 5.157 = 0.8867). The closer to 1, the better the model, the more accurate the prediction results. Conversely, The closer to 0, the worse the prediction effect of the model, and almost useless. The higher or lower directly determines the effectiveness of the model you use.
[0053] Reference Fig. 2 and 3, 44 cases of new children with ECMO treatment after ECMO intubation, the adjusted venous intubation position is the inferior vena cava into the right atrium, the arterial intubation is the innominate artery into the aortic arch, and the ECMO flow is stable. These new children are 0.1 (0.1, 1.0) months (0.1 is the median, 0.1 and 1.0 are the quartiles, that is, the numbers ranked in the 25th and 75th, the subsequent expression form contains the same meaning as this place), and the weight is 3.5 (2.9, 4.7) kg. The actual arterial intubation depth of the new children is 3 (3, 3.5) cm, and the predicted arterial intubation depth of the intubation formula is 3 (3, 3.2) cm. Paired t-test shows that: there is no difference between the actual arterial intubation depth and the predicted arterial intubation depth (p=0.932), and the paired correlation coefficient is 0.980. The difference between the predicted arterial intubation depth and the actual arterial intubation depth of all new children is less than 0.5cm. 95.5% (n=42) of the predicted arterial intubation depth of the new children is within 0.3cm of the actual arterial intubation depth. The actual venous intubation depth of the new children is 6.5 (6, 7) cm. The predicted venous intubation depth of the intubation formula is 6.3 (6.1, 6.7). Paired t-test shows that: there is no difference between the actual arterial intubation depth and the predicted arterial intubation depth (p=0.533), and the paired correlation coefficient is 0.989. The difference between the predicted venous intubation depth and the actual arterial intubation depth of 95.5% (n=42) of the new children is within 0.5cm.
[0054] Conclusion: The prediction formula of the intubation depth of pediatric transcarotid venous ECMO is calculated in this study (the arterial intubation prediction formula is: =0.109x + 2.679; The venous intubation prediction formula is: = 0.325x + 5.157), and the prediction formula is verified to be accurate, which provides an important reference for pediatric transcarotid venous ECMO intubation.
[0055] The above is only an embodiment of the present application, and does not limit the patent range of the present application, and any equivalent transformation or direct or indirect application in related technical fields based on the content of the specification and drawings of the present application is also included in the patent protection range of the present application.
Claims
1. A method for predicting the depth of ECMO cannulation in children via the jugular artery and vein, characterized in that, include: Data was collected by selecting children with congenital heart disease who underwent cardiac CTA or multiple children who underwent ECMO treatment via carotid artery and vein cannulation as data subjects, with each child weighing <30kg; the cannulation depth was determined based on the children's CTA images, with the cannulation depth starting from the incision location. The incision location methods are as follows: for infants under 6 months old, the ECMO incision is 1 cm above the right clavicular head; for children aged 6 months to 2 years, the ECMO incision is 1.5 cm above the right clavicular head; and for children over 2 years old, the ECMO incision is 2 cm above the right clavicular head. Based on the corresponding incision location, the depth of the vessel from the common carotid artery to the brachiocephalic artery entering the aortic arch at that incision location is measured as the ECMO arterial cannulation depth. Based on the corresponding incision location, the depth from the internal jugular vein to the inferior vena cava entering the right atrium at the corresponding incision location is measured as the ECMO venous cannulation depth. ; Establish a prediction formula and a coordinate system. The x-axis represents body weight (kg), and the y-axis represents intubation depth (cm). Plot the child's body weight x and arterial intubation depth... Depth of intravenous catheterization Using (x, ...) in a coordinate system ), (x, The formula for predicting arterial cannulation, based on statistical analysis, is as follows: =0.109x + 2.679, the formula for predicting intravenous cannulation is: = 0.325x + 5.157; Statistical analysis was linear regression analysis; The system outputs prediction results and inputs information about the prediction target, which is a new patient. The age of the new patient is input to determine the incision location, which is determined using the incision location positioning method. The weight x of the new patient is input into the arterial cannulation prediction formula and the venous cannulation prediction formula, and the predicted arterial cannulation depth and predicted venous cannulation depth are output for reference.
2. The method for predicting the insertion depth of ECMO via the carotid artery and vein in children according to claim 1, characterized in that, A paired t-test was performed on the predicted arterial cannulation depth and the actual arterial cannulation depth of the newborn; a paired t-test was also performed on the predicted venous cannulation depth and the actual venous cannulation depth of the newborn.
3. The method for predicting the insertion depth of ECMO cannulation in children via the jugular artery and vein according to claim 1, characterized in that, If the CTA examination is unclear and / or the child's clinical data is incomplete, the child's data will be removed.
4. The method for predicting the insertion depth of ECMO via the carotid artery and vein in children according to claim 1, characterized in that, Statistical analysis was performed using SPSS 25.0 software.
5. A pediatric transjugular artery and vein ECMO cannulation depth prediction system, characterized in that, include: The data module selects children with congenital heart disease who have undergone cardiac CTA examination or multiple children who have undergone ECMO treatment via carotid artery and vein cannulation as data subjects, and each child weighs <30kg; the cannulation depth is determined based on the child's CTA images, with the cannulation depth starting from the incision location; The incision location methods are as follows: for infants under 6 months old, the ECMO incision is 1 cm above the right clavicular head; for children aged 6 months to 2 years, the ECMO incision is 1.5 cm above the right clavicular head; and for children over 2 years old, the ECMO incision is 2 cm above the right clavicular head. Based on the corresponding incision location, the depth of the vessel from the common carotid artery to the brachiocephalic artery entering the aortic arch at that incision location is measured as the ECMO arterial cannulation depth. Based on the corresponding incision location, the depth from the internal jugular vein to the inferior vena cava entering the right atrium at the corresponding incision location is measured as the ECMO venous cannulation depth. ; The prediction module establishes a coordinate system with the x-axis representing body weight (kg) and the y-axis representing cannulation depth (cm). The module then plots the child's weight x-axis and arterial cannulation depth. Depth of intravenous catheterization Using (x, ...) in a coordinate system ), (x, The formula for predicting arterial cannulation, based on statistical analysis, is as follows: =0.109x + 2.679, the formula for predicting intravenous cannulation is: = 0.325x + 5.157; Statistical analysis was linear regression analysis; The output module takes the information of the prediction object as input. The prediction object is a new child. The age of the new child is input to determine the incision location. The incision location is determined by the incision location positioning method. The weight x of the new child is input into the arterial cannulation prediction formula and the venous cannulation prediction formula. The predicted arterial cannulation depth and the predicted venous cannulation depth are output for reference.
6. The pediatric transjugular artery and vein ECMO cannulation depth prediction system according to claim 5, characterized in that, A paired t-test was performed on the predicted arterial cannulation depth and the actual arterial cannulation depth of the newborn; a paired t-test was also performed on the predicted venous cannulation depth and the actual venous cannulation depth of the newborn.
7. The pediatric transjugular artery and vein ECMO cannulation depth prediction system according to claim 5, characterized in that, If the CTA examination is unclear and / or the child's clinical data is incomplete, the child's data will be removed.
8. The pediatric transjugular artery and vein ECMO cannulation depth prediction system according to claim 5, characterized in that, Statistical analysis was performed using SPSS 25.0 software.