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Lack of agreement between thermodilution and electrical velocimetry cardiac output measurements

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Abstract

Objective

The modified algorithm for the non-invasive determination of cardiac output (CO) by electrical bioimpedance—electrical velocimetry (EV®)—has been reported to give reliable results in comparison with echocardiography and pulmonary arterial thermodilution (PA-TD) in patients either before or after cardiac surgery. The present study was designed to determine whether EV®-CO measurements reflect intraindividual changes in CO during cardiac surgery.

Design

Prospective, observational study.

Setting

Operating room (OR) and intensive care unit (ICU) of a university hospital.

Patients

Twenty-nine patients undergoing elective cardiac surgery.

Interventions

None.

Measurements

CO was determined simultaneously by PA-TD and EV® after induction of anesthesia (t1) and 4.9 ± 3.5 h after ICU admission (t2).

Results

TD-CO was 3.9 ± 1.4 and 5.4 ± 1.1 l/min at t1 and t2 ( p < 0.0001). EV®-CO was 4.3 ± 1.1 and 4.9 ± 1.5 l/min at t1 and t2 ( p = 0.013). Bland–Altman analysis showed a bias of −0.4 l/min and 0.4 l/min and a precision of 3.2 and 3.6 l/min (34.3% and 67.4%) at t1 and t2, respectively. Analysis of the individual pre- to postoperative changes in CO with both methods revealed bidirectional changes in n = 12 patients and unidirectional changes with a difference greater than 50% and less than 50% in n = 9 and n = 8 patients, respectively.

Conclusions

The disagreement between PA-TD and EV®-CO measurements after anesthesia induction and after ICU admission, as well as the fact that thoracic bioimpedance did not adequately reflect pre- to postoperative changes in CO, questions the reliability of EV®-CO measurements in cardiac surgery patients and contrasts sharply with previous studies.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Matthias Heringlake, Ulrich Handke, Hartmut Gehring & Hermann Heinze

  2. Department of Cardiac Surgery, University of Luebeck, Luebeck, Germany

    Thorsten Hanke

  3. Department of Cardiology, University of Luebeck, Luebeck, Germany

    Frank Eberhardt

  4. Department of Anaesthesia, St. Thomas Hospital, London, UK

    Jan Schumacher

Authors
  1. Matthias Heringlake
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  2. Ulrich Handke
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  3. Thorsten Hanke
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  4. Frank Eberhardt
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  5. Jan Schumacher
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  6. Hartmut Gehring
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  7. Hermann Heinze
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Correspondence to Matthias Heringlake.

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Heringlake, M., Handke, U., Hanke, T. et al. Lack of agreement between thermodilution and electrical velocimetry cardiac output measurements. Intensive Care Med 33, 2168–2172 (2007). https://doi.org/10.1007/s00134-007-0828-3

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  • DOI: https://doi.org/10.1007/s00134-007-0828-3

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