Does obesity affect the non-invasive measurement of cardiac output performed by electrical cardiometry in children and adolescents?

Abstract

Electrical cardiometry (EC) is a non-invasive and inexpensive method for hemodynamic assessment and monitoring. However, its feasibility for widespread clinical use, especially for the obese population, has yet to be determined. In this study, we evaluated the agreement and reliability of EC compared to transthoracic Doppler echocardiography (TTE) in normal, overweight, and obese children and adolescents. We measured stroke volume (SV) and cardiac output (CO) of 131 participants using EC and TTE simultaneously. We further divided these participants according to BMI percentiles for subanalyses: <85% normal weight (n = 41), between 85 and 95% overweight (n = 7), and >95% obese (n = 83). Due to small sample size of the overweight group, we combined overweight and obese groups (OW+OB) with no significant change in results (SV and CO) before and after combining groups. There were strong correlations between EC and TTE measurements of SV (r = 0.869 and r = 0.846; p < 0.0001) and CO (r = 0.831 and r = 0.815; p < 0.0001) in normal and OW+OB groups, respectively. Bias and percentage error for CO measurements were 0.240 and 29.7%, and 0.042 and 29.5% in the normal and OW+OB groups, respectively. Indexed values for SV were lower in the OW+OB group than in the normal weight group when measured by EC (p < 0.0001) but no differences were seen when measured by TTE (p = 0.096). In all weight groups, there were strong correlations and good agreement between EC and TTE. However, EC may underestimate hemodynamic measurements in obese participants due to fat tissue.

Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis

“…Those full-text articles were assessed for eligibility, which led to 24 included studies and 17 excluded studies [18,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67]. The included studies were divided into 13 studies in adults [28][29][30][31][32][33][34][35][36][37][38][39][40] and 11 studies in pediatrics [41][42][43][44][45][46][47][48][49][50][51]. Contacting the manufacturer and screening of the reference lists of all included studies led to no additional studies.…”

“…Concerning adult studies; two were conducted in the OR during liver transplantation surgery [31,39], three during cardiac surgery [28,29,36], two both during cardiac surgery and post cardiac surgery in the ICU [30,33], two in the ICU [35,40], three in the cardiology unit [34,37,38] and one in the outpatient unit [32]. Concerning pediatric studies; four were conducted in the OR [45,47,49,50], two in the ICU [43,44], two in the neonatal intensive care unit (NICU) [46,51], and three in the outpatient unit [41,42,48]. The ICON ® device was used in nine studies [28, 29, 31, 32, 41-43, 45, 48] and the Aesculon ® in fifteen studies [30, 33-40, 44, 46, 47, 49-51].…”

The predictive value of the Pleth Variability Index on fluid responsiveness in spontaneously breathing anaesthetized children—A prospective observational study

“…Narula et al 12 conducted a study in children with a variety of structural congenital heart defects and concluded that ICON provides a reliable noninvasive estimation of CO. In another pediatric study Altamirano‐Diaz et al 13 found strong correlations for CO and SV measured simultaneously with ICON and transthoracic echocardiography, with the exception of obese patients, where electrovelocimetry tended to underestimate CO and SV.…”

The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

“…Electrical cardiometry has the advantage of being non-invasive, simple, user-friendly, and does not need expensive disposables. Electrical cardiometry was previously evaluated in the operating room in human patients [15], [20]; as well as animals [12].…”