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Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

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Abstract

Background

Cardiac output (CO) measurement in the intensive care unit (ICU) requires invasive devices such as the pulmonary artery (PA) catheter or arterial waveform pulse contour analysis (PCA). This study tests the accuracy and feasibility of point of care ultrasound (POCUS) of the common carotid artery to estimate the CO non-invasively and compare it to existing invasive CO measurement modalities.

Methods

Patients admitted to the surgical and cardiothoracic ICU in a tertiary university-affiliated academic center during a 4-month period, with invasive hemodynamic monitoring devices for management, were included in this cohort study. Common carotid artery POCUS was performed to measure the CO and the results were compared to an invasive device.

Results

Intensivists and ICU fellows, using ultrasound of the common carotid artery, obtained the CO measurements. Images of the Doppler flow and volume were obtained at the level of the thyroid gland. Concurrent CO measured via invasive devices was recorded. The patient cohort comprised 36 patients; 52 % were females. The average age was 59 ± 13 years, and 66 % were monitored via PCA device and 33 % via PA catheter. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect correlation (0.8152) between measurements of CO via ultrasound vs. invasive modalities. The ICC between POCUS and the invasive measurement via PCA was 0.84 and via PA catheter 0.74, showing substantial agreement between the ultrasound and both invasive modalities.

Conclusions

Common carotid artery POCUS offers a non-invasive method of measuring the CO in the critically ill population.

Abstract

Background

La misurazione della gittata cardiaca (CO) in Unità di Terapia Intensiva (ICU) richiede dispositivi invasivi come il cateterismo dell’arteria polmonare (PA) o l’analisi dell’onda dell’impulso arterioso (PCA). Questo studio si propone di valutare l’accuratezza e la fattibilità dell’ecografia (POCUS) della carotide comune per stimare la CO in modo non invasivo e confrontarla con le modalità esistenti di misurazione della CO effettuate in maniera invasiva.

Metodi

I pazienti ricoverati in terapia intensiva chirurgica e cardiotoracica in un centro accademico, affiliato con l’università, nel corso di un periodo di quattro mesi, sottoposti a dispositivi di monitoraggio emodinamico invasivo sono stati inclusi in questo studio. E’ stata eseguita l’ecografia dell’arteria carotide comune per misurare la CO ed i risultati sono stati confrontati con una tecnica invasiva.

Risultati

Medici di terapia intensiva e borsisti, utilizzando l’ecografia della carotide comune, hanno ottenuto le misurazioni della CO. Immagini del flusso Doppler e di volume sono state ottenute a livello della ghiandola tiroidea. Contemporaneamente è è stata registrata la CO mediante dispositivi invasivi. Il gruppo era costituito da 36 pazienti; Il 52 % erano femmine. L’età media era di 59 ± 13 anni, e il 66 % sono stati monitorati tramite dispositivo PCA e il 33 % tramite catetere PA. L’analisi del coefficiente di correlazione (ICC) ha dimostrato la correlazione quasi perfetta (0,8152) tra le misurazioni della CO con gli ultrasuoni e quelle con modalità invasive. Il ICC tra POCUS e la misurazione invasiva tramite PCA era 0,84 e catetere della PA era 0,74 mostrando sostanziale accordo tra l’ecografia e entrambe le modalità invasive.

Conclusioni

La POCUS dell’arteria carotide comune offre un metodo non invasivo per misurare la CO nel paziente critico.

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Acknowledgments

Sonosite ultrasound equipment grant for the duration of the study.

Conflict of interest

The authors have no conflicts of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrollment in the study and to the inclusion in this article of information that could potentially lead to their identification. The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.

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Authors and Affiliations

  1. Division of Trauma and Critical Care/Department of Surgery/Senior Staff, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, Michigan, MI, 48202, USA

    Marika Gassner, Keith Killu, Zachary Bauman, Victor Coba, Kelly Rosso & Dionne Blyden

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  1. Marika Gassner
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  2. Keith Killu
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  3. Zachary Bauman
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  4. Victor Coba
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  5. Kelly Rosso
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  6. Dionne Blyden
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Correspondence to Marika Gassner.

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Gassner, M., Killu, K., Bauman, Z. et al. Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods. J Ultrasound 18, 127–133 (2015). https://doi.org/10.1007/s40477-014-0139-9

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  • DOI: https://doi.org/10.1007/s40477-014-0139-9

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