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

Department of Intensive Care, Service de Réanimation Polyvalente, Centre Hospitalier de Narbonne, Bd Dr Lacroix, F-11100 Narbonne, France.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 08/2012; 109(6). DOI: 10.1093/bja/aes298
Source: PubMed


The esCCO monitor (ECG- estimated Continuous Cardiac Output, Nihon Kohden®) is a new non-invasive tool for estimating cardiac output (CO). It derives CO from the pulse wave transit time (PWTT) estimated by the ECG and the plethysmographic wave. An initial calibration is needed to refine the relation linking pulse pressure (measured by arterial pressure cuff) to PWTT. To assess the accuracy and reliability of the esCCO system, we performed an analysis of agreement of CO values obtained by transthoracic echocardiography (TTE).Methods
Thirty-eight intensive care unit patients were prospectively included. CO was determined simultaneously using esCCO (CO esCCO) and TTE (COTTE) as our reference method.ResultsA total of 103 paired readings from 38 patients were collected. The correlation coefficient between COesCCO and COTTE was 0.61 (P<0.001). The Bland and Altman analysis corrected for repeated measures showed a bias of -1.6 litre min-1 and limits of agreement from -4.7 to 1.5 litre min-1, with a percentage error (2 sd/mean CO) of 49. The correlation for CO changes was significant (R0.63, P<0.001), but the concordance rate was poor (73). Polar plot analysis showed an angular bias of -9° with radial limits of agreement from -54° to 36°. The bias appeared to correlate with systemic vascular resistance (R-0.45, P<0.001).Conclusions
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.

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    • "In one of its simplest form, PWA is based on the assumption that SV is proportional to arterial pulse pressure (hereafter called pulse pressure (PP)) [16] [17] [18] [19]. In fact, there are many existing evidences supporting this assumption [20] [21] [26]. "
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    ABSTRACT: Arterial pulse pressure has been widely used as surrogate of stroke volume, for example, in the guidance of fluid therapy. However, recent experimental investigations suggest that arterial pulse pressure is not linearly proportional to stroke volume. However, mechanisms underlying the relation between the two have not been clearly understood. The goal of this study was to elucidate how arterial pulse pressure and stroke volume respond to a perturbation in the left ventricular blood volume based on a systematic mathematical analysis. Both our mathematical analysis and experimental data showed that the relative change in arterial pulse pressure due to a left ventricular blood volume perturbation was consistently smaller than the corresponding relative change in stroke volume, due to the nonlinear left ventricular pressure-volume relation during diastole that reduces the sensitivity of arterial pulse pressure to perturbations in the left ventricular blood volume. Therefore, arterial pulse pressure must be used with care when used as surrogate of stroke volume in guiding fluid therapy.
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    • "The rationale behind this is that animal studies have shown a strong correlation between the SV and the PWTT. The only up-to-date validation study has demonstrated a clinically unacceptable performance of the device when compared to the CO values obtained with transthoracic echocardiography [7]. "
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    ABSTRACT: The monitoring of the cardiac output (CO) and other hemodynamic parameters, traditionally performed with the thermodilution method via a pulmonary artery catheter (PAC), is now increasingly done with the aid of less invasive and much easier to use devices. When used within the context of a hemodynamic optimization protocol, they can positively influence the outcome in both surgical and non-surgical patient populations. While these monitoring tools have simplified the hemodynamic calculations, they are subject to limitations and can lead to erroneous results if not used properly. In this article we will review the commercially available minimally invasive CO monitoring devices, explore their technical characteristics and describe the limitations that should be taken into consideration when clinical decisions are made.
    Full-text · Article · Sep 2013
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    ABSTRACT: We determined reliability of cardiac output (CO) measured by pulse wave transit time cardiac output system (esCCO system; COesCCO) vs transthoracic echocardiography (COTTE) in mechanically ventilated patients in the early phase of septic shock. A secondary objective was to assess ability of esCCO to detect change in CO after fluid infusion. Mechanically ventilated patients admitted to the ICU, aged >18 years, in sinus rhythm, in the early phase of septic shock were prospectively included. We performed fluid infusion of 500ml of crystalloid solution over 20 minutes and recorded CO by EsCCO and TTE immediately before (T0) and 5 minutes after (T1) fluid administration. Patients were divided into 2 groups (responders and non-responders) according to a threshold of 15% increase in COTTE in response to volume expansion. In total, 25 patients were included, average 64±15 years, 15 (60%) were men. Average SAPSII and SOFA scores were 55±21.3 and 13±2, respectively. ICU mortality was 36%. Mean cardiac output at T0 was 5.8±1.35 L/min by esCCO and 5.27±1.17 L/min by COTTE. At T1, respective values were 6.63 ± 1.57 L/min for esCCO and 6.10±1.29 L/min for COTTE. Overall, 12 patients were classified as responders, 13 as non-responders by the reference method. A threshold of 11% increase in COesCCO was found to discriminate responders from non-responders with a sensitivity of 83% (95% CI, 0.52-0.98) and a specificity of 77% (95% CI, 0.46-0.95). We show strong correlation esCCO and echocardiography for measuring CO, and change in CO after fluid infusion in ICU patients.
    Full-text · Article · Jun 2015 · PLoS ONE
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