{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T04:35:47Z","timestamp":1780115747539,"version":"3.54.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Model 2 demonstrated Root Mean Square Errors (RMSE) of 15.23\u2009mmHg (diastolic arterial blood pressure), 19.50BPM (heart rate), 2.94% (peripheral oxygen saturation), and 1.42\u2009mmHg (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag047","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T12:38:09Z","timestamp":1771418289000},"source":"Crossref","is-referenced-by-count":1,"title":["Building an Extracorporeal Membrane Oxygenation Digital Twin Using High-Resolution Patient Data: An artificial intelligence model for virtual reality simulation"],"prefix":"10.1093","author":[{"given":"Samuel","family":"Max","sequence":"first","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mounir","family":"Bourass","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"van der Mee Mendes","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"van der Mee Mendes","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]},{"name":"Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bram","family":"Schalkwijk","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaheer","family":"Babar","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Lim","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Elzo Kraemer","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Kaufman","sequence":"additional","affiliation":[{"name":"NYU Langone Health Departments of Medicine, Anesthesiology and Neurosurgery, , New York, New York, 10010,","place":["USA"]},{"name":"VA Health Center , New York, New York, 10010,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renske","family":"Brekelmans","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Westbroek","sequence":"additional","affiliation":[{"name":"Erasmus MC University Medical Center Department of Cardiothoracic Surgery, , Rotterdam,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrhman","family":"Mostafa Ali","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Hugo","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Klautz","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]},{"name":"Amsterdam UMC Department of Cardiothoracic Surgery, , Amsterdam,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Braun","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edris","family":"Mahtab","sequence":"additional","affiliation":[{"name":"Leiden University Medical Center Department of Cardiothoracic Surgery, , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,19]]},"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag047\/66993669\/ivag047.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag047\/66993669\/ivag047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:17:32Z","timestamp":1771528652000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article\/doi\/10.1093\/icvts\/ivag047\/8490769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag047","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]},"article-number":"ivag047"}}