Building an Extracorporeal Membrane Oxygenation Digital Twin Using High-Resolution Patient Data: An artificial intelligence model for virtual reality simulation

Interdisciplinary CardioVascular and Thoracic Surgery

Abstract

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe cardiopulmonary failure, but structured training remains constrained by costs, logistics, and the absence of validated high-fidelity simulators. This study aimed to develop an ECMO digital twin capable of supporting training in virtual reality (VR). METHODS: We integrated high-frequency ECMO machine data with electronic health record information from 335 patients across two centres. Data streams were synchronised at a 30-second resolution. A hierarchical two-stage system was designed: Model 1 predicted ECMO device outputs, while Model 2 combined those outputs with patient vital functions such as heart rate and blood pressure. This model was integrated into a VR simulation and underwent testing by 21 experts. RESULTS: Model 2 demonstrated Root Mean Square Errors (RMSE) of 15.23 mmHg (diastolic arterial blood pressure), 19.50BPM (heart rate), 2.94% (peripheral oxygen saturation), and 1.42 mmHg (end-tidal carbon dioxide) on the test set. Neural networks produced clinically coherent predictions. The models were implemented in an Unreal Engine-based VR simulator using the open neural network exchange format, with real-time latency inference and scenario switching. Expert testing confirmed good performance and clinically plausible physiological responses in the simulation. CONCLUSIONS: High-resolution ECMO data can be transformed into a digital twin for VR training. This framework broadens access to advanced ECMO education and establishes a foundation for multicentre validation, federated learning, and future expansion towards a critical-care digital-twin platform.

Authors 17

1. Samuel A Max Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

2. Mounir Bourass Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

3. Andre van der Mee Mendes Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

4. Daniel Van Der Mee Mendes Aachen

   Leiden University Medical Center · Erasmus MC

   Affiliation as printed

   Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

5. Bram Schalkwijk Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

6. Zaheer U.D. Babar

   Erasmus MC

   Affiliation as printed

   Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,

7. Lydia Lim Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

8. Carlos V. Elzo Kraemer Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

9. Bella Kaufman

   United States Department of Veterans Affairs · NYU Langone Health · New York University

   Affiliation as printed

   NYU Langone Health Departments of Medicine, Anesthesiology and Neurosurgery, , New York, New York, 10010,

   VA Health Center , New York, New York, 10010,

10. Antony van Dijk

    Erasmus MC

    Affiliation as printed

    Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,

11. Renske Brekelmans

    Erasmus MC

    Affiliation as printed

    Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,

12. Priscilla Westbroek

    Erasmus MC

    Affiliation as printed

    Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,

13. Abdelrhman Mostafa Ali Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

14. Juan Hugo Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

15. Robert J.M. Klautz Aachen

    Leiden University Medical Center · Amsterdam University Medical Centers

    Affiliation as printed

    Amsterdam UMC Department of Cardiothoracic Surgery, , Amsterdam,

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

16. Jerry Bruce Braun Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,

17. Edris A.F. Mahtab corresponding Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,