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

Abstract

Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min −1 [95% CI − 0.23; 0.29], LoA − 2.78 to 2.84 L min −1 and MPE 48.0%. For pediatrics, pooled bias was − 0.02 L min −1 [95% CI − 0.09; 0.05], LoA − 1.22 to 1.18 L min −1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I 2 = 93%, p < 0.0001) and pediatrics (I 2 = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.

Use of a Non-invasive Cardiac Output Measurement in a Patient with Low-output Dilated Cardiomyopathy

“…A recent review of the electrical velocimetry method mentioned that this method was unable to demonstrate high accuracy when measuring the CO ( 21 ); however, it was useful for monitoring trends in the CO, as in our case. According to comparisons made among the other non-invasive methods, including echocardiography and MRI in this case, the echocardiography method tended to underestimate the CO/CI, as the calculation assumes a perfect circle for the left ventricular outflow instead of the actual elliptical shape.…”

“…2). All methods of non-invasively measuring the CO require further improvements in order to acquire high precision (3,21) (Table). Clinical research on the correlation among CO values measured by different methods is needed.…”

Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study

“…In a recent published review and meta‐analysis on accuracy and precision of non‐invasive cardiac output monitoring by electrical cardiometry, Sanders M et al demonstrate low bias for both adults and pediatrics, but the mean percentage error was not clinically acceptable. They concluded that electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values, but that electrical cardiometry might still be applicable as a trend monitor to measure acute changes in cardiac output, which is relevant for clinical decision‐making 26 …”

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

“…A recent meta‐analysis including a subgroup analysis of 11 pediatric studies, comparing cardiac output values derived from electrovelocimetry and transthoracic echocardiography (n = 9) and thermodilution (n = 2), found a random effects pooled bias of −0.02 L/min [95% CI −0.09 to 0.05 L/min], a limit of agreement of −1.22 to 1.18 L/min, and a mean percentage (MPE) error of 42.0%. Considering a pooled MPE of <30% as acceptable, the authors concluded that despite a low bias electrovelocimetry is unlikely to completely replace echocardiography or thermodilution, but seems to be applicable as a trend monitor capable of measuring acute changes in cardiac output in both children and adults 14 …”