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Correlation of Electric Cardiometry and Continuous Thermodilution Cardiac Output Monitoring Systems

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DOI: 10.4236/wjcs.2014.47016    2,351 Downloads   3,192 Views   Citations


Purpose: Impedance Cardiography (ICG) with its drawbacks to reliably estimate cardiac output (CO) when compared to reference methods has led to the development of a novel technique called Electrical Cardiometry (EC). The purpose of this study was to compare EC-CO with the Continuous CO (CCO) derived from Pulmonary Artery Catheter (PAC). Methods: 60 patients scheduled to undergo coronary artery surgery necessitating the placement of PAC were studied in the operating room. Standard ECG electrodes were used for EC-CO measurements. Simultaneous CO measurement from EC and PAC was done at three predefined time points and were correlated. Results: A significant high correlation was found between the EC-CO and CCO at the three time points. Bland and Altman analysis revealed a bias of 0.08 L/min, a precision of 0.15 L/min, with a narrow limit of agreement (-0.13 to 0.28 L/min). The percentage error between the methods was 3.59%. Conclusion: The agreement between EC-CO and CCO is clinically acceptable and these two techniques can be used interchangeably. Mediastinal opening has no effect on the correlation between these two modalities.

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Malik, V. , Subramanian, A. , Chauhan, S. and Hote, M. (2014) Correlation of Electric Cardiometry and Continuous Thermodilution Cardiac Output Monitoring Systems. World Journal of Cardiovascular Surgery, 4, 101-108. doi: 10.4236/wjcs.2014.47016.


[1] Colucci, W.S. and Braunwald, E. (1997) Pathophysiology of Heart Failure. In: Braunwald, E., Ed., Heart Disease, A Textbook of Cardiovascular Medicine, WB Saunders, Philadelphia, 394-420.
[2] Sandham, J.D., Hull, R.D., Brant, R.F., Knox, L., Pineo, G.F., Doig, C.J., et al. (2003) A Randomized, Controlled Trial of the Use of Pulmonary-Artery Catheters in High-Risk Surgical Patients. The New England Journal of Medicine, 348, 5-14.
[3] Moshkovitz, Y., Kaluski, E., Milo, O., Vered, Z. and Cotter, G. (2004) Recent Developments in Cardiac Output Determination by Bioimpedance: Comparison with Invasive Cardiac Output and Potential Cardiovascular Applications. Current Opinion in Cardiology, 19, 229-237.
[4] Mathew, L. and Singh, R.K. (2006) Swan-Ganz Catheter in Hemodynamic Monitoring. Journal of Anaesthesiology Clinical Pharmacology, 22, 335-345.
[5] Fuller, H.D. (1992) The Validity of Cardiac Output Measurement by Thoracic Impedance: A Meta Analysis. Clinical & Investigative Medicine, 15, 103-112.
[6] Jensen, L., Yakimets, J. and Teo, K.K. (1995) A Review of Impedance Cardiography. Heart Lung, 24, 183-193.
[7] Marik, P., Pendelton, J. and Smith, R. (1997) A Comparison of Hemodynamic Parameters Derived from Transthoracic Electrical Bioimpedance with Those Parameters Obtained by Thermodilution and Ventricular Angiography. Chest, 25, 1545-1550.
[8] Raaijmakers, E., Faes, T.J., Scholten, R.J., Goovaerts, H.G. and Heethaar, R.M. (1999) A Meta-Analysis of Published Studies Concerning the Validity of Thoracic Impedance Cardiography. Annals of the New York Academy of Sciences, 873, 121-127.
[9] Kubo, S.H., Burchenal, J.E. and Cody, R.J. (1987) Comparison of Direct Fick and Thermodilution Cardiac Output Techniques at High Flow Rates. The American Journal of Cardiology, 59, 384-386.
[10] Kubicek, W.G., Kottke, J., Ramos, M.U., Patterson, R.P., Witsoe, D.A., Labree, J.W., et al. (1974) The Minnesota Impedance Cardiograph: Theory and Applications. BioMedical Engineering, 9, 410-416.
[11] Bernstein, D.P. (1986) A New Stroke Volume Equation for Thoracic Bioimpedance: Theory and Rationale. Critical Care Medicine, 14, 904-909.
[12] Bernstein, D.P. and Osypka, M.J. (2003) Apparatus and Method for Determining an Approximation of the Stroke Volume and the Cardiac Output of the Heart. US Patent 6,511,438 B2.
[13] Bland, J. and Altman, D.G. (1986) Statistical Methods for Assessing Agreement between Two Methods of Clinical Measurement. Lancet, 327, 307-310.
[14] Critchley, L.A.H. and Critchley, J.A.J.H. (1999) A Meta-Analysis of Studies Using Bias and Precision Statistics to Compare Cardiac Output Measurement Techniques. Journal of Clinical Monitoring and Computing, 15, 85-91.
[15] Mackenzie, J.D., Haites, N.E. and Rawles, J.M. (1986) Method of Assessing the Reproducibility of Blood Flow Measurement: Factors Influencing the Performance of Thermodilution Cardiac Output Computers. Heart, 55, 14-24.
[16] Stetz, C.W., Miller, R.G., Kelly, G.E. and Raffin, T.A. (1982) Reliability of the Thermodilution Method in the Determination of Cardiac Output in Clinical Practice. American Review of Respiratory Disease, 126, 1001-1004.
[17] Spiess, B.D., Patel, M.A., Soltow, L.O. and Wright, I.H. (2001) Comparison of Bioimpedance versus Thermodilution Cardiac Output during Cardiac Surgery: Evaluation of a Second-Generation BIOIMPEDANCE device. Journal of Cardiothoracic and Vascular Anesthesia, 15, 567-573.
[18] Suttner, S., Schollhorn, T., Boldt, J., Mayer, J., Rohm, K.D., Lang, K. and Piper, S.N. (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 Medicine, 32, 2053-2058.
[19] Lazar, S., Jerusalem, Z., Rube, J., Kolosky, C., Gojka, M., Dalal, B., et al. (2012) Electrical Cardiometry Compares Favorably with Thermodilution for Post Operative Hemodynamic Monitoring. Critical Care Medicine, 40, 386.
[20] Heringlake, M., Handke, U., Hanke, T., Eberhardt, F., Schumacher, J., Gehring, H. and Heinze, H. (2007) Lack of Agreement between Thermodilution and Electrical Velocimetry Cardiac Output Measurements. Intensive Care Medicine, 33, 2168-2172.
[21] Tomaske, M., Knirsch, W., Krestchmar, O., Woitzek, K., Balmer, C., Schmitz, A., et al. (2008) Cardiac Output Measurement in Children: Comparison of Aesculon Cardiac Ouput Monitor and Thermodilution. British Journal of Anaesthesia, 100, 517-520.
[22] Petter, H., Erik, A., Bjorn, E. and Goran, R. (2011) Measurement of Cardiac Output with Non-Invasive Aesculon Impedance versus Thermodilution. Clinical Physiology and Functional Imaging, 31, 39-47.
[23] Sageman, W.S., Riffenburg, R.H. and Spiess, B.D. (2002) Equivalance of Bioimpedece and Thermodilution in Measuring Cardiac Index after Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 16, 8-14.
[24] Gujjar, A.R., Muralidhar, K., Banakal, S., Gupta, R., Sathyaprabha, T.N. and Jairaj, P.S. (2008) Non Invasive Cardiac Output by Trans Thoracic Electrical Bioimpedance in Post Cardiac Surgery Patients: Comparison with Thermodilution Method. Journal of Clinical Monitoring and Computing, 22, 175-180.
[25] Chakravarthy, M., Rajeev, S. and Jawali, V. (2009) Cardiac Index Measurement by Invasive, Semi Invasive and Non Invasive Techniques: A Prospective Studying Postoperative Off Pump Coronary Artery Bypass Surgery Patients. Jour- nal of Clinical Monitoring and Computing, 23, 175-180.
[26] Summers, R.L., Shoemaker, W.C., Peacock, W.F., Ander, D.S. and Coleman, T.G. (2003) Bench to Bedside: Electrophysiologic and Clinical Principles of Noninvasive Hemodynamic Monitoring Using Impedance Cardiography. Academic Emergency Medicine, 10, 669-680.
[27] Zoremba, N., Bickenbach, J., Krauss, B., Rossaint, R., Kuhlen, R. and Schalte, G. (2007) Comparison of Electrical Velocimetry and Thermodilution Techniques for the Measurement of Cardiac output. Acta Anaesthesiologica Scandinavica, 51, 1314-1319.
[28] Van der Meer, B.J., de Vries, J.P., Schreuder, W.O., Bulder, E.R. and Eysman, L. (1997) Impedance Cardiography in Cardiac Surgery. Abnormal Body Weight Gives Unreliable Cardiac Output Measurements. Acta Anaesthesiologica Scandinavica, 41, 708-712.
[29] Kaukinen, S., Koobi, T., Bi, Y.B. and Turjanmaa, V.M.H. (2003) Cardiac Output Measurement after Coronary Artery Bypass Grafting Using Bolus Thermodilution, Continuous Thermodilution and Whole Body Impedance Cardiography. Journal of Cardiothoracic and Vascular Anesthesia, 17, 199-203.
[30] Noonan, P.M., Vishwanathan, S., Chambers, A. and Stumper, O. (2013) Non-Invasive Cardiac Output Monitoring during Catheter Interventions in Patients with Cavopulmonary Circulations. Cardiology in the Young, 17, 1-5.

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