Smart Glasses for Radial Arterial Catheterization in Pediatric Patients: A Randomized Clinical Trial

Abstract

Background Hand–eye coordination and ergonomics are important for the success of delicate ultrasound-guided medical procedures. These can be improved using smart glasses (head-mounted display) by decreasing the head movement on the ultrasound screen. The hypothesis was that the smart glasses could improve the success rate of ultrasound-guided pediatric radial arterial catheterization. Methods This prospective, single-blinded, randomized controlled, single-center study enrolled pediatric patients (n = 116, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the ultrasound screen group (control) or the smart glasses group. After inducing general anesthesia, ultrasound-guided radial artery catheterization was performed. The primary outcome was the first-attempt success rate. The secondary outcomes included the first-attempt procedure time, the overall complication rate, and operators’ ergonomic satisfaction (5-point scale). Results In total, 116 children were included in the analysis. The smart glasses group had a higher first-attempt success rate than the control group (87.9% [51/58] vs. 72.4% [42/58]; P = 0.036; odds ratio, 2.78; 95% CI, 1.04 to 7.4; absolute risk reduction, –15.5%; 95% CI, −29.8 to −12.8%). The smart glasses group had a shorter first-attempt procedure time (median, 33 s; interquartile range, 23 to 47 s; range, 10 to 141 s) than the control group (median, 43 s; interquartile range, 31 to 67 s; range, 17 to 248 s; P = 0.007). The overall complication rate was lower in the smart glasses group than in the control group (5.2% [3/58] vs. 29.3% [17/58]; P = 0.001; odds ratio, 0.132; 95% CI, 0.036 to 0.48; absolute risk reduction, 24.1%; 95% CI, 11.1 to 37.2%). The proportion of positive ergonomic satisfaction (4 = good or 5 = best) was higher in the smart glasses group than in the control group (65.5% [38/58] vs. 20.7% [12/58]; P <0.001; odds ratio, 7.3; 95% CI, 3.16 to 16.8; absolute risk reduction, –44.8%; 95% CI, –60.9% to –28.8%). Conclusions Smart glasses-assisted ultrasound-guided radial artery catheterization improved the first-attempt success rate and ergonomic satisfaction while reducing the first-attempt procedure time and overall complication rates in small pediatric patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Comparison of Single-operator Laser-assisted Ultrasound-guided Radial Arterial Cannulation in Young Children with Traditional Ultrasound Guidance: A Randomized Clinical Trial

“…4B), so it had a higher first-attempt success rate, higher midmost rate of first needle-tip entry into the artery, and fewer needle adjustments. In addition, compared with other studies, 8,[11][12][13][14][17][18][19] we used the ultrasonic probe arm innovatively. That is, after determining the best position of the needle tip, the ultrasonic position was stabilized by the arm, freeing the two hands for a more stable cannulation.…”

“…2,3 In view of various failure factors, compared with the traditional palpation approach, the advantages of ultrasound-guided arterial puncture are becoming increasingly notable. [4][5][6][7] In the recent decade, relevant studies have continuously proposed the optimization and improvement of ultrasound-guided arterial puncture technology and the methods to improve its success rate, such as using a dynamic needle tip, [8][9][10] developing lines, 11 intelligent glasses, 12 subcutaneous injection of normal saline or nitroglycerin, 3,13,14 guide wire assistance, or choosing an alternative artery. 15,16 Notwithstanding these advancements, there is no general consistency as to how to optimize radial artery cannulation for young pediatric patients.…”

Technology Behavior Model—Beyond Your Sight with Extended Reality in Surgery

“…The three analytical methods used in this study were quantitative analysis, exploratory analysis, and cross-sectional analysis. The main reason for this is that there is less information and trial data related to smart glasses research and the information is mainly about telesurgery, and surgical teaching [56,57]. This makes the available information related to clinical surgery more difficult to find, so this makes it more difficult for this study.…”

Point-of-Care Ultrasound in Austere Environments

“…The glasses and ultrasound combination can also be used for ultrasound-guided IV access, regional anesthesia, and other procedures. Previous work with head-mounted displays, such as smart glasses, has demonstrated enhanced ergonomics, improved ability to detect changes in patient status, and enhanced performance of ultrasound-guided procedures 4 -6 compared with screen displays. This combination does not require special equipment and can be configured with off-the-shelf equipment.…”