Evaluation of Impedance Cardiography as an Alternative to Pulmonary Artery Catheterization in Critically Ill Patients

Abstract

Invasive pulmonary artery catheterization has historically been the method of choice for the evaluation of hemodynamic status. Impedance cardiography (ICG) is an accurate, noninvasive technique to obtain hemodynamic status information without the risk and cost associated with invasive methods. The purpose of this prospective, observational study was to determine whether the availability of ICG could decrease the need for placement of a pulmonary artery catheter in critically ill patients in coronary care units. After the need for hemodynamic data was determined, ICG parameters were provided to the attending physician who then decided whether pulmonary artery catheter insertion was still necessary. Of 107 subjects enrolled in the study, 14 (13%; 95% confidence interval, 7.3%-21.0%) were judged by the treating physicians to have indications for hemodynamic monitoring. In these subjects, the provision of ICG data allowed the physician to avoid placement of a pulmonary artery catheter in 10/14 patients (71%; 95% confidence interval, 41.9%-91.6%). When ICG was utilized, clinicians reported that the information was helpful in 10/10 patients (100%; 95% confidence interval, 74.1%-100.0%) and improved outcome in 6/10 patients (60%; 95% confidence interval, 26.2%-87.8%). ICG can replace the pulmonary artery catheter in coronary care unit patients, and clinicians utilizing ICG believe it aids medical decision making and improves patient outcomes.

Non-invasive assessment of gestational hemodynamics: benefits and limitations of impedance cardiography versus other techniques

“…Silver et al concluded that >70% of the patients who would normally have been subjected to the risks of right heart catheterization, were managed successfully using only ICG technology [32]. Some papers even report a reproducibility superior to the invasive techniques [26].…”

Measuring impedance in congestive heart failure: Current options and clinical applications

“…A small observational series of patients with acute decompensated heart failure found that band electrode–derived impedance data avoided invasive catheterization in 10 of 14 patients and improved outcome in 6 of the 10 patients using impedance measurements (Table V). 71 Many studies tracked impedance data with therapeutic responses, but few examined how and whether the measured impedance changed or influenced therapy decisions. Three case studies showed that impedance-derived hemodynamic data were consistent for patients with acute heart failure before and after therapy and aided in determining dosage 76.…”

Improving the Accuracy of Impedance Cardiac Output in the Intensive Care Unit: Comparison With Thermodilution Cardiac Output

“…The support of clinicians for the introduction of any new technology is as important as the accuracy and reliability of that technology. Only with such support can impedance cardiography be accepted as a routine part of diagnostic support in the critically ill. Silver and colleagues 32 demonstrated that the presentation of impedance-derived hemodynamic data to critical care physicians when they felt that a PAC was indicated led to a 71% reduction in PAC usage and TDCO estimation.…”