Log in | Register

Electrical velocimetry as a tool for measuring cardiac output in small infants after heart surgery

Oswin Grollmuss| Serge Demontoux| André Capderou| Alain Serraf| Emre Belli
Pediatric Original
Volume 38, Issue 6 / June , 2012

Pages 1032 - 1039

Abstract

Purpose

Cardiac output (CO), the product of stroke volume (SV) and heart rate, is essential to guarantee organ perfusion, especially in the intensive care setting. As invasive measurement of CO bears the risk of complications there is a need for non-invasive alternatives. We investigated if electrical velocimetry (EV) and transthoracic Doppler (Doppler-TTE) are interchangeable for the non-invasive measurement of SV and able to reflect the post-surgical SV/CO trend.

Methods

Comparison of SV measurements by EV and Doppler-TTE was performed in 24 newborns after switch operation (n = 240 measurements). Three subgroups of measurements (=periods) were created according to the patients’ status in the course of post-surgical CO recovery.

Results

Bland–Altman analysis found acceptable bias and limits of agreement for the interchangeability of the two methods. Mean overall SV was 3.7 ml with a mean overall bias of 0.28 ml (=7.6 %). The mean percentage error of 29 % was acceptable according to the method of Critchley and Critchley. Overall precision expressed by the coefficient of variation (CV) was 6.6 % for SVTTE and 4.4 % for SVEV. SVTTE and SVEV medians in the three periods were significantly different and documented the post-surgical CO trend.

Conclusions

EV and Doppler-TTE are interchangeable for estimating SV. EV has the advantages of easy handling and allows continuous measurement.

Keywords

References

  1. Pinsky MR (2003) Why measure cardiac output? Crit Care 7:114–116
    • View reference on PubMed
    • View reference on publisher's website
  2. Tibby SM, Hatherill M, Marsh JJ, Murdoch I (1997) Clinicians’ abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child 77:516–518
    • View reference on PubMed
    • View reference on publisher's website
  3. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D (1970) Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 283:447–451
    • View reference on PubMed
    • View reference on publisher's website
  4. Gonzalez J, Delafosse Ch, Fartoukh M, Capderou A, Straus C, Zelter M, Derenne JP, Similowski T (2003) Comparison of bedside measurement of cardiac output with the thermodilution method and the Fick method in mechanically ventilated patients. Crit Care 7:171–178
    • View reference on PubMed
    • View reference on publisher's website
  5. Dhingra VK, Fenwick JC, Walley KR, Chittock DR, Ronco JJ (2002) Lack of agreement between thermodilution and Fick cardiac output in critically ill patients. Chest 122:990–997
    • View reference on PubMed
    • View reference on publisher's website
  6. Darmon PL, Hillel Z, Mogtader A, Mindich B, Thys D (1994) Cardiac output by transesophageal echocardiography using continuous wave Doppler across the aortic valve. Anesthesiology 80:796–805
    • View reference on PubMed
    • View reference on publisher's website
  7. Darmon PL, Hillel Z, Mogtader A, Thys DM (1996) A study of the human aortic valve orifice by transesophageal echocardiography. J Am Soc Echocardiogr 9:668–674
    • View reference on PubMed
    • View reference on publisher's website
  8. Valtier B, Cholley BP, Belot JP, de la Coussaye JE, Mateo J, Payen DM (1998) Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler. Am J Respir Crit Care Med 158:77–83
    • View reference on PubMed
  9. Hudson I, Houston A, Aitchison T, Holland B, Turner T (1990) Reproducibility of measurements of cardiac output in newborn infants by Doppler ultrasound. Arch Dis Child 65:15–19
    • View reference on PubMed
    • View reference on publisher's website
  10. Chew MS, Poelaert J (2003) Accuracy and repeatability of pediatric cardiac output measurement using Doppler: 20-year review of the literature. Intensive Care Med 29:1889–1894
  11. Kubicek WG, Karnegis JN, Patterson RP, Witsoe DA, Mattson RH (1966) Development and evaluation of an impedance cardiac output system. Aerosp Med 37:1208–1212
    • View reference on PubMed
  12. Osypka MJ, Bernstein DP (1999) Electrophysiologic principles and theory of stroke volume. Determination by thoracic electrical bioimpedance. AACN Clin Issues 10(3):385–399
  13. Bernstein DP, Lemmens HJ (2005) Stroke volume equation for impedance cardiography. Med Biol Eng Comput 43:443–450
    • View reference on PubMed
    • View reference on publisher's website
  14. Tomaske M, Knirsch W, Kretschmar O, Woitzek K, Balmer C, Schmitz A, Bauersfeld U, Weiss M, Working Group on Non-invasive Haemodynamic Monitoring in Paediatrics (2008) Cardiac output measurement in children: comparison of Aesculon cardiac output monitor and thermodilution. Br J Anaesth 100:517–530
  15. Tomaske M, Knirsch W, Kretschmar O, Balmer C, Woitzek K, Schmitz A, Bauersfeld U, Weiss M, Working Group on Noninvasive Haemodynamic Monitoring in Paediatrics (2009) Evaluation of the Aesculon cardiac output monitor by subxiphoidal Doppler flow measurement in children with congenital heart defects. Eur J Anaesthesiol 26:412–415
  16. Schmidt C, Theilmeier G, van Aken H, Korsmeier P, Wirtz SP, Berendes E, Hoffmeier A, Meissner A (2005) Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output. Br J Anaesth 95:603–610
    • View reference on PubMed
    • View reference on publisher's website
  17. Suttner S, Schöllhorn T, Boldt Mayer J, Röhm KD, Lang K, Piper SN (2006) Noninvasive assessment of cardiac output using thoracic electrical bioimpedance in hemodynamically stable and unstable patients after cardiac surgery: a comparison with pulmonary artery thermodilution. Intensive Care Med 32:2053–2058
  18. Norozi K, Beck C, Osthaus WA, Wille I, Wessel A, Bertram H (2007) Electrical velocimetry for measuring cardiac output in children with congenital heart disease. Br J Anaesth 100:88–94
    • View reference on PubMed
    • View reference on publisher's website
  19. Schubert S, Schmitz T, Weiss M, Nagdyman H, Huebler M, Alexi-Meskishvili V, Berger F, Stiller B (2008) Continuous, non-invasive techniques to determine cardiac output in children after cardiac surgery: evaluation of transesophageal Doppler and electric velocimetry. J Clin Monit Comput 22:299–307
    • View reference on PubMed
    • View reference on publisher's website
  20. Zulfiqar A, Umamaheswara Rao GS, Jaganath A (2009) Haemodynamic changes during craniotomy monitored by a bioimpedance plethysmographic non-invasive cardiac output monitor. J Clin Monit Comput 23:157–161
    • View reference on publisher's website
  21. Voss F, Becker R, Hauck M, Katus HA, Bauer A (2009) The basic pacing rate in CRT patients: the higher the better? Clin Res Cardiol 98:219–223
    • View reference on PubMed
    • View reference on publisher's website
  22. Wernovsky G, Wypij D, Ra Jonas, Mayer JE Jr, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castañeda AR, Newburger JW (1995) Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. Circulation 92:2226–2235
    • View reference on PubMed
  23. Cannesson M, Bionda C, Gostoli B, Raisky O, di Filippo S, Bompard D, Védrinne C, Rousson R, Ninet J, Neidecker J, Lehot JJ (2007) Time course and prognostic value of plasma B-type natriuretic peptide concentration in neonates undergoing the arterial switch operation. Anesth Analg 104:1059–1065
    • View reference on PubMed
    • View reference on publisher's website
  24. Bland M, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310
    • View reference on PubMed
    • View reference on publisher's website
  25. Critchley LA, Critchley JA (1999) A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 15:85–91
    • View reference on PubMed
    • View reference on publisher's website
  26. Preiss D, Fisher J (2008) A measure of confidence in Bland-Altman analysis for the interchangeability of two methods of measurement. J Clin Monit Comput 22:257–259
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement