Abstract
Objective: This study was conducted to compare the cardiac output by using Electrical Cardiometry (EC), a noninvasive method of continuous cardiac output monitoring during cardiac surgery with pulmonary artery catheter (PAC) derived cardiac output. Design: Prospective observational clinical study. Setting: Cardiac surgery operating room of a tertiary care cardiac center. Participants: Twenty five patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Measurements and Main Results: A total of 150 double data of cardiac output were compared with Thermodilution Cardiac Output (TDCO) and Thoracic Electrical Bioimpedance (TEBCO). The TDCO value ranges from 1.8-6.9 litre·min－1 with a mean of 4.39 ± 1.16 litre·min－1 and TEBCO ranges from 1.8-7.1 litre·min－1 with a mean of 4.21 ± 1.16 litre·min－1. The averaged Bland-Altman analysis for TDCO and TEBCO revealed that a mean bias was 0.18 and limit of agreement was －1.25 - 0.89 litre·min－1 and the percentage error (PE) ranged from 22%-32%. The precision for the TDCO was measured to be ±16.2% and the precision for TEBCO was ±19.6%. Receiver Operating Characteristic (ROC) curve analysis between TDCO and TEBCO with a cutoff of 15% shows a sensitivity of 84% and specificity of 63 and area under ROC curve of 0.80. Mountain plot between TDCO and TEBCO shows that a median percentile is 0.25 and value of 97.5 percentile is 1.525. Conclusions: The present study indicates that the electric cardiometry device yields numerically comparable results to cardiac outputs derived from the PAC during the cardiac surgery. Therefore, electrical cardiometry can be used to evaluate haemodynamic variables with clinically acceptable accuracy, when invasive methods are to be avoided or not available.
Highlights
Assessment of the cardiac output (CO) is recommended during the initial evaluation of haemodynamically compromised patients, which often takes place in the operating room, emergency department or the intensive care unit (ICU) [1] [2]
The present study indicates that the electric cardiometry device yields numerically comparable results to cardiac outputs derived from the pulmonary artery catheter (PAC) during the cardiac surgery
Electrical Cardiometry (EC) is a new monitor for non-invasive method of measuring continuous cardiac output monitoring based on measurement of thoracic electrical bioimpedance
Summary
The thermodilution method of deriving CO using a pulmonary artery catheter (PAC) is considered as the gold standard for measuring cardiac output [3] [4]. Electrical Cardiometry (EC) is a new monitor for non-invasive method of measuring continuous cardiac output monitoring based on measurement of thoracic electrical bioimpedance. Bioimpedance CO is based on the principle that cyclical increases in blood volume in the great vessels, as well as alignment of red blood cells in the thoracic aorta resulting from increased velocity, cause concomitant decreases in the electrical impedance in the chest. Changes in thoracic bioimpedance are induced by ventilation and pulsatile blood flow, and processing of the signal results in a characteristic impedence (Z) waveform. For measurement of Stroke volume (SV), only the cardiac-induced pulsatile component of the total change in electrical impedance is analyzed (dZ/dt), as the respiratory component is filtered out. EC interprets the maximum change in thoracic electrical bioimpedance as the ohmic equivalent of the mean aortic blood flow acceleration and further transforms it into an equivalent of mean aortic blood flow velocity
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