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The Estimated Fick Method Systematically Over-Estimates Cardiac Index Compared to Thermodilution in Children

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Abstract

Cardiac index (CI) may be derived from the Fick method, using measured or estimated oxygen consumption (VO2), or from thermodilution. In children, LaFarge VO2 estimates correlate poorly with measured VO2 values. In a large adult cohort, there was only modest correlation between estimated Fick CI (eFick CI) and thermodilution CI (TDCI). We evaluated the extent of agreement between eFick CI using LaFarge estimates of VO2 and TDCI in a pediatric cohort. A retrospective, single-center chart review of patients 3–18 years of age who underwent cardiac catheterization with documented eFick CI and TDCI from 2004 to 2020 included 201 catheterizations from 161 unique patients. The mean patient age at catheterization was 12.2y (SD 4.4y). The most frequent diagnosis was cardiomyopathy, followed by congenital heart disease and pulmonary hypertension. TDCI and eFick CI differed by > 20% in 49% of catheterizations. eFick CI systematically exceeded TDCI by a mean percentage difference of 24% (SD 31%). Higher mean CI ((eFick CI + TDCI)/2) and older age were predictive of greater percent difference between eFick CI and TDCI. For each increase in mean CI by 1.0 L/min/m2, the expected percent difference in CI increased by 9.9% (p < 0.001). In pediatric patients undergoing cardiac catheterization, eFick CI with LaFarge VO2 systematically exceeds TDCI. The difference between methods is frequently > 20%, which may have clinically significant implications. Discrepancies between eFick CI and TDCI increase at higher mean CI.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CI:

Cardiac index

CO:

Cardiac output

eFick CI:

Estimated Fick method cardiac index

NOS:

Not otherwise specified

PVRI:

Pulmonary vascular resistance index

TDCI:

Thermodilution cardiac index

VO2 :

Oxygen consumption

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Acknowledgements

We thank Eric Vu, MD for his expertise in and discussion of anesthesia practices in the cardiac catheterization laboratory.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Box 21, Chicago, IL, 60611, USA

    Andrew A. Lawson, Paul Tannous & Karl Migally

  2. Center for Cardiovascular Innovation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Christina Laternser

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  1. Andrew A. Lawson
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  2. Paul Tannous
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  3. Christina Laternser
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  4. Karl Migally
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Contributions

AAL and KM formulated the study and wrote the manuscript. AAL collected the data. CL analyzed the data. AAL, PT, CM, and KM analyzed the results and reviewed the manuscript. All authors approved of the final manuscript.

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Correspondence to Andrew A. Lawson.

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All authors declare that they have no competing interests.

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The study was approved by the Lurie Children’s Hospital IRB. The study was HIPAA compliant and informed consent was waived.

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Lawson, A.A., Tannous, P., Laternser, C. et al. The Estimated Fick Method Systematically Over-Estimates Cardiac Index Compared to Thermodilution in Children. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03491-z

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