Comparison of Cardiac Output Measurement by Noninvasive Method with Electrical Cardiometry and Invasive Method with Thermodilution Technique in Patients Undergoing Coronary Artery Bypass Grafting

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.

[1]  T. Raffin,et al.  Reliability of the thermodilution method in the determination of cardiac output in clinical practice. , 2015, The American review of respiratory disease.

[2]  Vikas Sharma,et al.  Comparison of transthoracic electrical bioimpedance cardiac output measurement with thermodilution method in post coronary artery bypass graft patients. , 2011, Annals of cardiac anaesthesia.

[3]  N. Cook.  Methods for evaluating novel biomarkers – a new paradigm , 2010, International journal of clinical practice.

[4]  S. Rajeev,et al.  Cardiac index value measurement by invasive, semi-invasive and non invasive techniques: a prospective study in postoperative off pump coronary artery bypass surgery patients , 2009, Journal of clinical monitoring and computing.

[5]  M. van Meurs,et al.  Bench-to-bedside review: Angiopoietin signalling in critical illness – a future target? , 2009, Critical care.

[6]  M. Cecconi,et al.  Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies – with specific reference to the measurement of cardiac output , 2009, Critical care.

[7]  K. Thennarasu,et al.  Noninvasive Cardiac Output Measurement by Transthoracic Electrical Bioimpedence: Influence of Age and Gender , 2008, Journal of Clinical Monitoring and Computing.

[8]  T. Sathyaprabha,et al.  Non-invasive Cardiac Output by Transthoracic Electrical Bioimpedence in Post-cardiac Surgery Patients: Comparison with Thermodilution Method , 2008, Journal of Clinical Monitoring and Computing.

[9]  J. Boldt,et al.  RETRACTED ARTICLE: Noninvasive assessment of cardiac output using thoracic electrical bioimpedance in hemodynamically stable and unstable patients after cardiac surgery: a comparison with pulmonary artery thermodilution , 2006, Intensive Care Medicine.

[10]  S. Gottlieb,et al.  Impedance cardiography: More questions than answers , 2006, Current cardiology reports.

[11]  Mitchell M. Levy,et al.  Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock , 2004, Critical care medicine.

[12]  Bekele Afessa,et al.  Increased risk associated with pulmonary artery catheterization in the medical intensive care unit. , 2003, Journal of critical care.

[13]  John C. Chaney,et al.  Minimally invasive hemodynamic monitoring for the intensivist: Current and emerging technology , 2002, Critical care medicine.

[14]  B. Spiess,et al.  Equivalence of bioimpedance and thermodilution in measuring cardiac index after cardiac surgery. , 2002, Journal of cardiothoracic and vascular anesthesia.

[15]  I. Wright,et al.  Comparison of bioimpedance versus thermodilution cardiac output during cardiac surgery: evaluation of a second-generation bioimpedance device. , 2001, Journal of cardiothoracic and vascular anesthesia.

[16]  H Belzberg,et al.  Outcome prediction of emergency patients by noninvasive hemodynamic monitoring. , 2001, Chest.

[17]  L. Critchley,et al.  A Meta-Analysis of Studies Using Bias and Precision Statistics to Compare Cardiac Output Measurement Techniques , 1999, Journal of Clinical Monitoring and Computing.

[18]  K. Heath,et al.  A devastating complication of inadvertent carotid artery puncture. , 1998, Anesthesiology.

[19]  K. Muralidhar.  Complication of femoral artery pressure monitoring. , 1998, Journal of cardiothoracic and vascular anesthesia.

[20]  P. Marik,et al.  A comparison of hemodynamic parameters derived from transthoracic electrical bioimpedance with those parameters obtained by thermodilution and ventricular angiography. , 1997, Critical care medicine.

[21]  J S Krouwer,et al.  A simple, graphical method to evaluate laboratory assays. , 1995, European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies.

[22]  J. Boldt,et al.  [The pulmonary artery catheter]. , 1993, Der Anaesthesist.

[23]  O. Kemmotsu,et al.  [Valve injury: a new complication of internal jugular vein cannulation]. , 1992, Masui. The Japanese journal of anesthesiology.

[24]  E. Robin.  Death by pulmonary artery flow-directed catheter. Time for a moratorium? , 1987, Chest.

[25]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[26]  J. MacKenzie,et al.  Method of assessing the reproducibility of blood flow measurement: factors influencing the performance of thermodilution cardiac output computers. , 1986, British heart journal.

[27]  A. Connors,et al.  Complications of right heart catheterization. A prospective autopsy study. , 1985, Chest.

[28]  G. Diamond,et al.  Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. , 1970, The New England journal of medicine.