Abstract
Objective
Thoracic electrical bioimpedance (TEB) cardiac output (CO) is being explored increasingly as a non-invasive alternative to the pulmonary artery catheter (PAC). This study compared TEB-CO measured using a new instrument – NICOMON (Larsen & Toubro Ltd. India) with thermodilution (Td) CO in post-cardiac surgery patients.
Methods
Postoperative cardiac surgical patients requiring a PAC for their management were studied. TEB-CO was measured by passing a 4 mA RMS alternating current across the chest and measuring the analog bioimpedence across the thorax. Kubicek equation was used to estimate TEB-CO. Td-CO was measured using a PAC. Bland-Altman analysis was used to compare paired data.
Results
One hundred and ninety-seven pairs of CO measurements were made by the two methods among 35 patients. Mean TEB-CO was 5.15 ± 1.27 l/min and mean Td-CO was 5.22 ± 1.28 l/min. Pearson correlation coefficient (r) for these measurements was 0.856 (P < 0.01), with bias −0.0651 l and precision: ±1.37 l/min. The percentage error of measurement of this precision was 26.44%. Cardiac index also correlated among the two methods (r = 0.789; P = 0.01).
Conclusions
Thoracic electrical bioimpedance cardiac output compares favorably with thermodilution method among post-cardiac surgery patients. Further studies are indi- cated with this instrument to validate its efficacy in various clinical situations and utility in monitoring hemodynamic interventions.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM, Sopko G, Califf RM. Impacts of the pulmonary artery catheter in critically Ill patients: meta-analysis of randomized trials. J Am Med Assoc 2005; 294: 1634–1670
Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW. ESCAPE investigators and ESCAPE Study Coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. J Am Med Assoc 2005; 294: 1625–1633
Barin E, Dinesh G, Haryadi, Segel I, Schookin, Dwayne R, Westenkow, et al. Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization. Crit Care Med 2000; 28: 698–702
Shoemaker WC, Belzberg H, Wo CCJ, et al. Multicenter study of noninvasive monitoring systems as alternatives to invasive monitoring of acutely ill emergency patients. Chest 1998; 114: 1643–1652
Appel PL, Kram HB, Mackabee J, Fleming AW, Shoemaker WC. Comparison of measurements of cardiac output by bioimpedence and thermodilution in severely ill surgical patients. Crit Care Med 1986; 14: 933–935
Zeigler D, Grotti L, Krucke G. Comparison of cardiac output measurements by TEB vs intermittent bolus thermodilution in mechanical ventilated patients. Chest 1999; 116: 281S (Abstract)
Hirschl MM, Kittler H, Woisetschläger C, Siostrzonek P, Staudinger T, Kofler J, Oschatz E, Bur A, Gwechenberger M, Laggner AN. Simultaneous comparison of thoracic bioimpedance and arterial pulse waveform-derived cardiac output with thermodilution measurement. Crit Care Med 2000; 28: 1798–1802
Fuller HD. The validity of cardiac output measurements by thoracic impedance: A meta-analysis. Clin Invest Med 1992; 15: 103–112
Raaijmakers E, Faes TJC, Scholten RJPM, et al. A meta-analysis of three decades of validating thoracic impedance cardiography. Crit Care Med 1999; 27: 1203–1213
**dal GD, Ananthakrishnan TS, Kataria SK, Deshpande AK. An introduction to impedance cardio-vasography. Bhabha Atomic Research Center publication, Mumbai, India, 2001
Kubicek W, Patterson RP, et al. Impedance cardiography as a non-invasive method of monitoring cardiac functions and other parameters of the cardiovascular system. Annals of New York Academy of Sciences 1970: 724–732
Bland JM, Altmal DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet 1995; 346: 1085–1087
Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput 1999; 15: 85–91
Van De Water JM, Miller TW, Vogel RL, Mount BE, Dalton ML. Impedance cardiography: the next vital sign technology? Chest 2003; 123: 2028–2033
Thomas AN, Ryan J, Doran BR, Pollard BJ. Bioimpedance versus thermodilution cardiac output measurement: the Bomed NCCOM3 after coronary bypass surgery. Intensive Care Med. 1991; 17: 383–386
Koobi T, Kaukinen S, Turjanmaa VM. Cardiac output can be reliably measured noninvasively after coronary artery bypass grafting operation. Crit Care Med 1999; 27: 2206–2211
Acknowledgements
This research was supported by Larsen & Toubro (India) Ltd., Electrical & Electronics Division, Mysore, India. The sponsors however did not influence the study design, execution, analysis or conclusions. The authors acknowledge Prof. **dal GD, Bhabha Atomic Research Institute, Mumbai, India for expert advice and guidance; Dr. Janaki for assistance in data collection and the ICU nursing and technical staff at Narayana Institute of Cardiac Sciences for their support.
Author information
Authors and Affiliations
Corresponding author
Additional information
Gujjar AR, Muralidhar K, Banakal S, Gupta R, Sathyaprabha TN, Jairaj PS. Non-invasive cardiac output by transthoracic electrical bioimpedence in post-cardiac surgery patients: comparison with thermodilution method.
Rights and permissions
About this article
Cite this article
Gujjar, A.R., Muralidhar, K., Banakal, S. et al. Non-invasive Cardiac Output by Transthoracic Electrical Bioimpedence in Post-cardiac Surgery Patients: Comparison with Thermodilution Method. J Clin Monit Comput 22, 175–180 (2008). https://doi.org/10.1007/s10877-008-9119-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-008-9119-y