Abstract
Hemorrhage is a leading cause of trauma death, particularly in prehospital environments when evacuation is delayed. Obtaining central vascular access to a deep artery or vein is important for administration of emergency drugs and analgesics, and rapid replacement of blood volume, as well as invasive sensing and emerging life-saving interventions. However, central access is normally performed by highly experienced critical care physicians in a hospital setting. We developed a handheld AI-enabled interventional device, AI-GUIDE (Artificial Intelligence Guided Ultrasound Interventional Device), capable of directing users with no ultrasound or interventional expertise to catheterize a deep blood vessel, with an initial focus on the femoral vein. AI-GUIDE integrates with widely available commercial portable ultrasound systems and guides a user in ultrasound probe localization, venous puncture-point localization, and needle insertion. The system performs vascular puncture robotically and incorporates a preloaded guidewire to facilitate the Seldinger technique of catheter insertion. Results from tissue-mimicking phantom and porcine studies under normotensive and hypotensive conditions provide evidence of the technique’s robustness, with key performance metrics in a live porcine model including: a mean time to acquire femoral vein insertion point of 53 ± 36 s (5 users with varying experience, in 20 trials), a total time to insert catheter of 80 ± 30 s (1 user, in 6 trials), and a mean number of 1.1 (normotensive, 39 trials) and 1.3 (hypotensive, 55 trials) needle insertion attempts (1 user). These performance metrics in a porcine model are consistent with those for experienced medical providers performing central vascular access on humans in a hospital.
Highlights
Vascular access is critical to trauma management, permitting the administration of emergency drugs, analgesics, and blood volume replacement [1]
Single-frame vessel detection was tested on 930 ultrasound images of the femoral artery and vein under both normotensive and hypotensive conditions, as used in the current AI-GUIDE system
The area under the curve (AUC) for the artery is larger than for the vein, at 0.97 (0.96–0.98) vs. 0.93 (0.92–0.95), which highlights the greater challenge of vein detection due to higher variability in morphology
Summary
Vascular access is critical to trauma management, permitting the administration of emergency drugs, analgesics, and blood volume replacement [1]. Critical barriers to obtaining central vascular access in the field include a lack of in-field advanced ultrasound image interpretation skills and proficiency with image-guided vascular needle placement. Our work addresses these issues, enabling medical providers with minimal vascular access expertise to proficiently obtain central vascular access in prehospital settings. Wbihfuerncapteirofnorimncerdeaisnes thteheopritsikmoafl preseguiodno,atnheeurryisskmoafnpdsaerutderoiaonveeunroyussmfisstaunladfoarrmteraitoiovnen[1o1u,s12f]i.stWulhaeins ploerwfoarmnded blienedthinegopcotimmpallicreagtiioonns, tchaenrbisekeoafspilysemudaonaangeeudrywsimths danirdecatrpterreisosvuerneo. uTshefislteunlgatihs olofwthaant d rebglieoendiisngrecfeormrepdlitcoataisonthsec“aancbceesesalseinlygtmh”aninagTeadblwe 1ithanddiriesc,topnraevsseurareg.e,T8hecmle.nAgnthatoofmtihcat varreigaiboinlitiys irneftehreremd etodiaasl–tlhaete“raacl cpeosssitleionngtohf”thine Tnaebulreo1vaasncduliasr, obnunadvelerawgiet,h8incmth.eAfenmatoormalic trivaanrgialebialintdy ivnesthseel mdeepdtihalb–olattherpaolspeofsuirtitohnerocfhtahlelenneguersofvoarsncueeladrlebutanrdgeletiwngit.hAinddthiteiofnemalloyr,al intr6i5a%ngolfepaenodpvlee,stsheel dcoemptmh obnotfhempoosrealfuartehreyr pcharatlilaelnlygeosvfeorrlanpesetdhle ctaormgemtionngf.eAmdodriatliovneainlly, ininth6e5a%ntoefroppeosptleer,itohrepclaonmem[1o3n],fwemhiocrhalpalarctersythpearatritaelrly aotvaedrldaiptsiotnhaelcroismkmofoinjfuermyodruarlivnegin atitnemthpeteadntvereonpipoustnecrtiourrep.lane [13], which places the artery at additional risk of injury during attempted venipuncture
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