Original article
Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output

Presented in part at the Annual Meeting of the American Society of Anesthesiologists, Orlando, FL, October 12–16, 2002.
https://doi.org/10.1053/j.jvca.2004.01.025Get rights and content

Abstract

Objective: Continuous measurement of cardiac output (CCO) is of great importance in the critically ill. However, pulmonary artery thermodilution has been questioned for possible complications associated with right heart catheterization. Furthermore, measurements are delayed in the continuous mode during rapid hemodynamic changes. A new pulmonary artery catheter CCO device (Aortech, Bellshill, Scotland) enabling real-time update of cardiac output was compared with 2 different, less-invasive methods of CCO determination, esophageal Doppler and pulse contour analysis.

Design: Prospective, observational study.

Setting: University hospital, single institution.

Participants: Patients scheduled for elective coronary artery bypass grafting (CABG).

Interventions: None.

Measurements and Main Results: CCO measurements wereanalyzed using a Bland-Altman plot. Bias between CCO and pulse contour cardiac output (PCCO), and Doppler-derived cardiac output (UCCO) was (mean ± 1 SD) −0.71 ± 1 L/min versus −0.15 ± 1.09 L/min, and between UCCO and PCCO −0.58 ± 1.06 L/min. Bias was not significantly different among methods, nor were comparative values before and after cardiopulmonary bypass (p > 0.05).

Conclusions: Agreement between the CCO method and both less-invasive measurements was clinically acceptable. There were no adverse events associated with the use of either device.

Section snippets

Methods

After approval of the institutional review board committee and after written informed consent, 10 American Society of Anesthesiologists physical status IV patients with impaired left ventricular function (ejection fraction <50%) scheduled for elective cardiac surgery (coronary artery bypass grafting) were enrolled in the study. Patients with valvular heart disease, intracardiac shunts, or peripheral vascular disease, as well as emergency cases, were excluded. Only patients with sinus rhythm in

Results

Ten patients (aged 56–78 years; 6 male, 4 female) were enrolled in the study. A total of 113 PCCO, 107 UCCO, and 113 CCO measurements were analyzed. CO measurements ranged from 1.89 to 8.6 L/min for PCCO, 1.5 to 8.2 L/min for UCCO, and 2.4 to 5.7 L/min for CCO.

The Bland-Altman plot for CCO and PCCO is shown in Figure 1, for UCCO and CCO in Figure 2, and for PCCO and UCCO in Figure 3. Bias between CCO and PCCO was −0.71 L/min (precision 1 L/min), between CCO and UCCO −0.15 L/min (precision

Discussion

Perioperative determination of cardiac output is of great interest in the critically ill. Since 1970, PAC thermodilution has become the clinical “gold standard” in the field of anesthesia and intensive care. However, right heart catheterization for CO monitoring has been questioned for various reasons. First, ICO shows remarkable variance and has proved to be no real reference method in comparison studies.8, 9 Second, until recently, there was no real CCO measurement by PA thermodilution. The

References (31)

  • J.P Tournadre et al.

    Overestimation of low cardiac output measured by thermodilution

    Br J Anaesth

    (1997)
  • W.T Jellema et al.

    Continuous cardiac output in septic shock by simulating a model of the aortic input impedanceA comparison with bolus injection thermodilution

    Anesthesiology

    (1999)
  • L.C Siegel et al.

    Delayed time response of the continuous cardiac output pulmonary artery catheter

    Anesth Analg

    (1996)
  • M Aranda et al.

    Continuous cardiac output cathetersDelay in in vitro response time after controlled flow changes

    Anesthesiology

    (1998)
  • A.F Connors et al.

    The effectiveness of right-heart catheterization in the initial care of critically ill patients. SUPPORT Investigators

    JAMA

    (1996)
  • Cited by (0)

    View full text