Journal of Clinical Monitoring and Computing

, Volume 32, Issue 2, pp 227–234 | Cite as

Reliability of thermodilution derived cardiac output with different operator characteristics

  • Scott C. McKenzie
  • Kimble Dunster
  • Wandy Chan
  • Martin R. Brown
  • David G. Platts
  • George Javorsky
  • Chris Anstey
  • Shaun D. Gregory
Original Research
First Online:
Received:
Accepted:

Abstract

Cardiac output (CO) is commonly measured using the thermodilution technique at the time of right heart catheterisation (RHC). However inter-operator variability, and the operator characteristics which may influence that, has not been quantified. Therefore, this study aimed to assess inter-operator variability with the thermodilution technique using a mock circulation loop (MCL) with calibrated flow sensors. Participants were blinded and asked to determine 4 levels of CO using the thermodilution technique, which was compared with the MCL calibrated flow sensors. The MCL was used to randomly generate CO between 3.0 and 7.0 L/min through changes in heart rate, contractility and vascular resistance with a RHC inserted through the MCL pulmonary artery. Participant characteristics including gender, specialty, age, height, weight, body-mass index, grip strength and RHC experience were recorded and compared to determine their relationship with CO measurement accuracy. In total, there were 15 participants, made up of consultant cardiologists (6), advanced trainees in cardiology (5) and intensive care consultants (4). The majority (9) had performed 26–100 previous RHCs, while 4 had performed more than 100 RHCs. Compared to the MCL-measured CO, participants overestimated CO using the thermodilution technique with a mean difference of +0.75 ± 0.71 L/min. The overall r2 value for actual vs measured CO was 0.85. The difference between MCL and thermodilution derived CO declined significantly with increasing RHC experience (P < 0.001), increasing body mass index (P < 0.001) and decreasing grip strength (P = 0.033). This study demonstrated that the thermodilution technique is a reasonable method to determine CO, and that operator experience was the only participant characteristic related to CO measurement accuracy. Our results suggest that adequate exposure to, and training in, the thermodilution technique is required for clinicians who perform RHC.

Keywords

Cardiac output Thermodilution Pulmonary artery catheterisation Clinical measurements Measurement precision 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

This study was approved by The Prince Charles Hospital Ethics Committee (approval number HREC/13/QPCH/38).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Stewart GN. Researches on the Circulation Time and on the Influences which affect it. J Physiol. 1897;22(3):159.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Henriques V. Uber die Verteilung des Blutes vom linken Herzen zwischendem Herzen und dem übrigen Organismus. Biochemische Zeitschrift. 1913;56:230–48.Google Scholar
  3. 3.
    Hamilton WF, Riley RL. Comparison of the Fick and dye injection methods of measuring the cardiac output in man. Am J Physiol. 1948;153(2):309.PubMedGoogle Scholar
  4. 4.
    Fegler G. Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q J Exp Physiol Cogn. Med Sci. 1954;39(3):153–64.PubMedGoogle Scholar
  5. 5.
    Fegler G. The reliability of the thermodilution method for determination of the cardiac output and the blood flow in central veins. Q J Exp Physiol Cogn. Med Sci. 1957;42(3):254–66.PubMedGoogle Scholar
  6. 6.
    Ganz W, Donoso R, Marcus HS, Forrester JS, Swan HJ. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol. 1971;27(4):392–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Timms D, Gregory S, Greatrex N, Pearcy MJ, Fraser JF, Steinseifer U. A compact mock circulation loop for the in vitro testing of cardiovascular devices. Artif Organs. 2011;35(4):384–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69–74.PubMedGoogle Scholar
  9. 9.
    Gregory SD, Greatrex N, Timms D, Gaddum N, Pearcy MJ, Fraser JF. Simulation and enhancement of a cardiovascular device test rig. J Simul. 2010;4:34–41.CrossRefGoogle Scholar
  10. 10.
    Gregory SD, Stevens M, Timms D, Pearcy M, editors. Replication of the Frank-Starling Response in a Mock Circulation Loop. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS; 2011 August 30–Sept 3; Boston, USA.Google Scholar
  11. 11.
    Green SB. How many subjects Does It Take To Do A regression analysis. Multivar Behav Res. 1991;26(3):499–510.CrossRefGoogle Scholar
  12. 12.
    Gregory SD, Cooney H, Diab S, Anstey C, Thom O, Fraser JF. In vitro evaluation of an ultrasonic cardiac output monitoring (USCOM) device. J Clin Monit Comput. 2016;30(1):69–75.CrossRefPubMedGoogle Scholar
  13. 13.
    Moise SF, Sinclair CJ, Scott DHT. Pulmonary artery blood temperature and the measurement of cardiac output by thermodilution. Oxford: Blackwell Publishing; 2002. pp. 562–6.Google Scholar
  14. 14.
    Spinale FG, Mukherjee R, Tanaka R, Zile MR. The effects of valvular regurgitation on thermodilution ejection fraction measurements. Chest. 1992;101(3):723–31.CrossRefPubMedGoogle Scholar
  15. 15.
    Cigarroa RG, Lange RA, Williams RH, Bedotto JB, Hillis LD. Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. Am J Med. 1989;86(4):417–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Hamilton MA, Stevenson LW, Woo M, Child JS, Tillisch JH. Effect of tricuspid regurgitation on the reliability of the thermodilution cardiac output technique in congestive heart failure. Am J Cardiol. 1989;64(14):945–8.CrossRefPubMedGoogle Scholar
  17. 17.
    McKenzie S, Brown M, Platts D, Javorsky G. The influence of tricuspid valve regurgitation on the calculation of cardiac output measurement during right heart catheterisation. Heart Lung Circ. 2011;20(Supplement 2):S149–S50.CrossRefGoogle Scholar
  18. 18.
    Konishi T, Nakamura Y, Morii I, Himura Y, Kumada T, Kawai C. Comparison of thermodilution and Fick methods for measurement of cardiac output in tricuspid regurgitation. Am J Cardiol. 1992;70(4):538–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Johnson RW, Normann RA. Signal processing strategies for enhancement of signal-to-noise ratio of thermodilution measurements. Ann Biomed Eng. 1988;16(3):265–78.CrossRefPubMedGoogle Scholar
  20. 20.
    Johnson RW, Normann RA. Central venous blood temperature fluctuations and thermodilution signal processing in dogs. Ann Biomed Eng. 1989;17(6):657–69.CrossRefPubMedGoogle Scholar
  21. 21.
    Bazaral MG, Bazaral MG, Petre J, Novoa R. Errors in thermodilution cardiac output measurements caused by rapid pulmonary artery temperature decreases after cardiopulmonary bypass. Anesthesiology. 1992;77(1):31–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Thrush DN, Varlotta D. Thermodilution cardiac output: comparison between automated and manual injection of indicator. J Cardiothorac Vasc Anesth. 1992;6(1):17–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Baylor P. Lack of agreement between thermodilution and Fick methods in the measurement of cardiac output. J Intensive Care Med. 2006;21(2):93–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Nunez S, Maisel A. Comparison between mixed venous oxygen saturation and thermodilution cardiac output in monitoring patients with severe heart failure treated with milrinone and dobutamine. Am Heart J. 1998;135(3):383–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Gonzalez J, Delafosse C, Fartoukh M, Capderou A, Straus C, Zelter M, et al. Comparison of bedside measurement of cardiac output with the thermodilution method and the Fick method in mechanically ventilated patients. Crit Care. 2003;7(2):171–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Scott C. McKenzie
    • 1
    • 2
  • Kimble Dunster
    • 3
  • Wandy Chan
    • 1
    • 2
  • Martin R. Brown
    • 1
    • 2
  • David G. Platts
    • 1
    • 2
    • 3
  • George Javorsky
    • 2
  • Chris Anstey
    • 1
    • 4
  • Shaun D. Gregory
    • 1
    • 3
    • 5
  1. 1.Faculty of Health Sciences, School of MedicineThe University of QueenslandBrisbaneAustralia
  2. 2.The Prince Charles HospitalChermsideAustralia
  3. 3.Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research GroupThe Prince Charles HospitalBrisbaneAustralia
  4. 4.Nambour General HospitalNambourAustralia
  5. 5.School of EngineeringGriffith UniversityBrisbaneAustralia

Personalised recommendations