Emergency cardiac procedures are often done in resource and time constrained environments. One such procedure is the placement of a temporary pacing wire (TPW). These are inserted into patients on an emergency basis to stabilize their condition for transport to a medical centre that can insert a permanent pacemaker. This procedure involves the insertion of the TPW into a distal vein, such as the internal jugular in the neck or subclavian in the superior chest, and the advancement of the TPW towards the heart. Ideally, this procedure can be performed under fluoroscopic x-ray visualization, giving the clinician a view of the placement of the TPW. Such feedback can be critical to the success of the procedure, as TPWs can easily travel down the wrong branch of the venous system. Even in cases where the TPW is placed in the heart, unstable or non-ideal placement can result in dislodgement, requiring another surgical intervention or potential loss of life. Fluoroscopic guidance requires both costly equipment and a technician operator, either of which is often unavailable in rural and remote care centers, especially outside of normal business hours and due to post-COVID labour shortages. Electromagnetic (EM) tracking is frequently used in existing cardiac catheters, but not in TPWs. EM tracking tracks the three-dimensional position and orientation of miniatures sensors. This proposal uses a TPW prototype modified to include EM tracking to determine if this more affordable and available tracking modality improves surgical outcomes over blind procedures. This tracked TPW prototype will be used to demonstrate the efficacy of EM tracking in TPW surgery by comparison of a tracked and blind procedure performed in a phantom. Chart review research will also be completed to demonstrate the failures of blind insertions on Vancouver Island to further demonstrate the need for tracked TPWs.
This project will develop multiple technical and soft research skills for the interns. First, the interns will develop their technical skills in medical device development and validation, in computer assisted interventions, and in mechatronic system design. As well, they will gain skills in collaborative research methods that will enable them to work effectively with clinicians and health administrators, which are critical skills for a successful career in the medical device design industry.
This project and the associated internships will support Island Health (the designated health organization partner) by yielding a proof of concept system that can be the first step to a clinically deployable, low-cost and personnel neutral tool that can help to overcome the challenges that exist with not being able to rapidly and successfully placement temporary pacing wires in rural and remote hospital settings, which is a challenge across the majority of the health authorities catchment.