Ultrasound-based monitoring of cardiac output after off-pump coronary artery bypass grafting

N.N. Izotova1, 2, Y.Yu. Ilyina1, 2, E.V. Fot1, 2, A.A. Smetkin1, 2, V.V. Kuzkov1, 2, M.Yu. Kirov1, 2

Northern State Medical University, Arkhangelsk

2 Volosevich First City Clinical Hospital, Arkhangelsk

For correspondence: Kirov Mikhail Yu. — MD, PhD, professor, Head of the Department of Anesthesiology and Intensive care of Northern State Medical University, Arkhangelsk; e-mail: mikhail_kirov@hotmail.com

For citation: Izotova NN, Il’ina YaYu, Fot EV, et al. Ultrasound-based monitoring of cardiac output after off-pump coronary artery bypass grafting. Alexander Saltanov Intensive Care Herald. 2018;2:57–60.

DOI: 10.21320/1818-474X-2018-2-57-60


Aim of the study. To assess the accuracy of USCOM in patients after off-pump coronary artery bypass grafting (OPCAB).

Methods. We enrolled 14 patients who underwent elective OPCAB into an ongoing prospective observational study. The measurements of cardiac index (CI) based on USCOM (CIUSCOM) in comparison with thermodilution CI (CITD) were performed at seven stages during postoperative period. Statistical analysis included assessment of agreement in absolute values of CI using Bland–Altman analysis.

Results. Totally, 98 pairs of data were collected. According to Bland–Altman analysis of all pairs of data, mean bias between CIUSCOM and CITD was –1.09 L/min/m2 with limits of agreement of ±1.18 L/min/m2 and percentage error of 63 %. In a subgroup of stages with requirement of mechanical ventilation the intermethod bias was –1.16 L/min/m2 with limits of agreement of ±1.15 L/min/m2 and percentage error of 67 %, in a subgroup of stages after tracheal extubation the mean bias was –1.00 L/min/m2 with limits of agreement of ±1.23 L/min/m2 and percentage error of 59 %.

Conclusions. USCOM demonstrates poor accuracy with underestimation of CI compared to thermodilution technique both before and after tracheal extubation. This method can not be recommended as an acceptable alternative in cardiac surgery.

Keywords: cardiac index, hemodynamics, monitoring of hemodynamics, off-pump coronary artery bypass grafting

Received: 31.03.2018


References

  1. Смeткин А.А., Хуссейн А., Захаров В.И., Изотова Н.Н.и др. Точность неинвазивного измерения сердечного выброса на основе оценки времени транзита пульсовой волны при аортокоронарном шунтировании на работающем сердце. Патология кровообращения и кардиохирургия. 2016; 20(2): 104–110. [Smetkin A.A., Hussain A., Zakharov V.I., Izotova N.N., et al. Reliability of non-invasive cardiac output monitoring based on pulse wave transit time in off-pump coronary artery bypass grafting. Pathology of blood circulation and heart surgery. 2016; 20(2): 104–110. (In Russ)].
  2. СметкинА.А., Хуссейн А., Фот Е.В., Изотова Н.Н. и др. Инвазивный мониторинг сердечного выброса по времени транзита пульсовой волны после аортокоронарного шунтирования на работающем сердце. Вестник анестезиологии и реаниматологии. 2016; 13(5): 4–10. [Smetkin A.A., Hussain A., Fot E.V., Izotova N.N., et al. Invasive monitoring of cardiac output by pulse wave transit time after aortocoronary bypass on the beating heart. Messenger of anesthesiology and resuscitation. 2016; 13(5): 4–10. (In Russ)].
  3. Smetkin A., Hussain A., Fot E., Izotova N.,et al. Estimated continuous cardiac output based on pulse wave transit time in off-pump coronary artery bypass grafting: a comparison with transpulmonary thermodilution. Journal of Clinical Monitoring and Computing. 2017; 31(2): 361–370.
  4. Fot E., Kuzkov V., Gromova J., Izotova N.,et al. Mini-fluid challenge and PEEP-test can predict fluid responsiveness after off-pump coronary surgery. European Journal of Anaesthesiology. 2015; 32(e-Suppl. 53): 215.
  5. Dey I., Sprivuls P. Emergency physicians can reliably assess emergency department patient cardiac output using the USCOM continuous wave Doppler cardiac output monitor. Emergency Medicine Australasia. 2005; 17: 193–199.
  6. Stewart G.M., Nguyen H.B., Kim T.Y.,et al. Inter-Rater Reliability for Noninvasive Measurement of Cardiac Function in Children. Pediatric Emergency Care. 2008; 24(7): 433–437.
  7. Kager С.C.M., Dekker G. A., Stam M.C. Measurement of cardiac output in normal pregnancy by a non-invasive two-dimensional independent Doppler device. Australian and New Zealand Journal of Obstetrics and Gynecology. 2009; 49: 142–144.
  8. Thom O., Taylor D., Wolfe R., et al. Comparison of a supra-sternal cardiac output monitor (USCOM) with the pulmonary artery catheter. British Journal of Anaesthesia. 2009; 103(6): 800–804.
  9. Meyer S., Todd D. A., Shadboldt B. Assessment of portable continuous wave Doppler ultrasound (ultrasonic cardiac output monitor) for cardiac output measurements in neonates. Journal of Pediatrics and Child Health. 2009; 45(7–8): 464–468.
  10. Wentland A.L., Grist T.M., Wieben O. Review of MRI-based measurements of pulse wave velocity: a biomarker of arterial stiffness. Cardiovasc. Diagn. Ther. 2014; 4: 193–206.
  11. Patel N., Dodsworth M., Mills J. F. Cardiac output measurement in newborn infants using the ultrasonic cardiac output monitor: an assessment of agreement with conventional echocardiography, repeatability and new user experience. Archives of Disease in Childhood — Fetal and Neonatal Edition. 2010; 96(3): 206–211.
  12. Nguyen H.B., Banta D., Stewart G. et al. Cardiac index measurements by transcutaneous doppler ultrasound and transthoracic echocardiography in adult and pediatric emergency patients. Journal of Clinical Monitoring and Computing. 2010; 24(3): 237–247.