Comparison of esCCO and transthoracic echocardiography for non-invasive measurement of cardiac output intensive care

Bataille, B.; Bertuit, M.; Mora, Michel; Mazerolles, Michel; Cocquet, Pierre-Henri; Masson, B.; Moussot, Pierre-Etienne; Ginot, J.; Silva, S.; Larché, Jérôme

doi:10.1093/bja/aes298

Cited by 57 publications

(44 citation statements)

References 31 publications

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“…A previous study reported a significant correlation between spontaneous changes in CO TTE and CO esCCO over time in critically ill patients. 9 The same study also showed a poor concordance rate and finally concluded that esCCO failed to trend CO reliably. Recently, Kim et al suggested that the variations of PWTT were correlated with invasive systolic blood pressure during induction of anesthesia and could represent a valuable alternative to invasive systolic blood pressure in high-risk hypertensive patients.…”

Section: Discussionmentioning

confidence: 92%

“…A systematic calibration of noninvasive brachial pressure before each measurement of CO esCCO could improve the reliability of the device; however, a recent study found that this approach failed to improve agreement between TTE and esCCO. 9 These last results emphasize the lack of interchangeability between esCCO and TTE. In contrast, studies using both a pulmonary artery catheter and invasive continuous arterial pressure for external calibration showed a good correlation between absolute values of CO measurements.…”

Section: Discussionmentioning

confidence: 93%

“…On the basis of a previous report 9 16 The percentage error to determine acceptable limits of agreement between both devices was calculated using the formula given by Critchley and Critchley. 17 Trends were analyzed using polar plotting of CO changes among consecutive time points, as previously described.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, acute changes in arterial compliance are not taken into account, even when serial noninvasive brachial pressure measurements are performed. 9 The use of vasopressors could strongly modify the CO measurement taken with the esCCO device. Nevertheless, our results were similar when patients receiving norepinephrine were excluded from the analysis (data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Another study conducted in the intensive care unit (ICU) to compare noninvasive esCCO without external CO calibration with TTE was less straightforward. 9 Further validation studies using different comparators and conducted in various subgroups of high-risk patients are highly desirable before recommending a wider use of esCCO at the bedside, in the ICU, or in the operating room.…”

Section: Résumémentioning

confidence: 99%

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The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Estimated continuous cardiac output (esCCO) is a new and noninvasive cardiac output (CO) monitoring device using pulse wave transit time. The aim of this study was to assess rapid changes in CO using esCCO (DCO esCCO ) without invasive calibration and to compare the results with those using transthoracic Doppler echocardiography (DCO TTE ). Methods Fifty-four consecutive patients were enrolled in this study following elective cardiac surgery. The CO esCCO and CO TTE were collected during four consecutive steps: 1) at baseline, 2) during passive leg raising (PLR), 3) at return to baseline, and 4) after a fluid challenge. The relationship between DCO esCCO and DCO TTE induced by PLR and a fluid challenge was assessed and a polar plot analysis was performed. Relationship, Bland-Altman analysis, and percentage error for absolute values of CO esCCO and CO TTE were also performed. Results Twenty-four patients were excluded from the analysis. No correlation was found between DCO esCCO and DCO TTE during PLR (r = 0.07; P = 0.732; n = 30) and after a fluid challenge (r = 0.24; P = 0.394; n = 14). The polar plot analysis showed that 21 data points (87%) of significant changes in CO were above the 30°radial sector lines and confirmed that esCCO was unable to track changes in CO. A weak positive relationship was found between absolute values of CO esCCO and CO TTE (r = 0.28; P = 0.004). Bias, precision, and limits of agreement were 0.25 LÁmin -1 , 2.4 LÁmin -1 , and -4.4 to 4.9 LÁmin -1 , respectively. The percentage error was 80%. Conclusions Estimated continuous cardiac output without external calibration seems unable to assess rapid changes in CO following cardiac surgery and was not interchangeable with transthoracic Doppler echocardiography.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 3 more Smart Citations

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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Hemodynamic Monitoring: What’s Out There? What’s Best for You?

Latham

2018

Adult Critical Care Medicine

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Metaanalysen zur Messgenauigkeit nichtinvasiver hämodynamischer Überwachungstechnologien bei Erwachsenen

et al. 2018

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An ideal non-invasive monitoring system should provide accurate and reproducible measurements of clinically relevant variables that enables clinicians to guide therapy accordingly. The monitor should be rapid, easy to use, readily available at the bedside, operator-independent, cost-effective and should have a minimal risk and side effect profile for patients. An example is the introduction of pulse oximetry, which has become established for non-invasive monitoring of oxygenation worldwide. A corresponding non-invasive monitoring of hemodynamics and perfusion could optimize the anesthesiological treatment to the needs in individual cases. In recent years several non-invasive technologies to monitor hemodynamics in the perioperative setting have been introduced: suprasternal Doppler ultrasound, modified windkessel function, pulse wave transit time, radial artery tonometry, thoracic bioimpedance, endotracheal bioimpedance, bioreactance, and partial CO rebreathing have been tested for monitoring cardiac output or stroke volume. The photoelectric finger blood volume clamp technique and respiratory variation of the plethysmography curve have been assessed for monitoring fluid responsiveness. In this manuscript meta-analyses of non-invasive monitoring technologies were performed when non-invasive monitoring technology and reference technology were comparable. The primary evaluation criterion for all studies screened was a Bland-Altman analysis. Experimental and pediatric studies were excluded, as were all studies without a non-invasive monitoring technique or studies without evaluation of cardiac output/stroke volume or fluid responsiveness. Most studies found an acceptable bias with wide limits of agreement. Thus, most non-invasive hemodynamic monitoring technologies cannot be considered to be equivalent to the respective reference method. Studies testing the impact of non-invasive hemodynamic monitoring technologies as a trend evaluation on outcome, as well as studies evaluating alternatives to the finger for capturing the raw signals for hemodynamic assessment, and, finally, studies evaluating technologies based on a flow time measurement are current topics of clinical research.

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Comparison of esCCO and transthoracic echocardiography for non-invasive measurement of cardiac output intensive care

Abstract: In critically ill patients, the performance of the esCCO monitor was not clinically acceptable, and this monitor cannot be recommended in this setting. Moreover, the esCCO failed to trend CO data reliably.

Cited by 57 publications

References 31 publications

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Hemodynamic Monitoring: What’s Out There? What’s Best for You?

Metaanalysen zur Messgenauigkeit nichtinvasiver hämodynamischer Überwachungstechnologien bei Erwachsenen

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