Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: a systematic review and meta-analysis

Abstract

Cardiac output (CO) measurement is crucial for the guidance of therapeutic decisions in critically ill and high-risk surgical patients. Newly developed completely non-invasive CO technologies are commercially available; however, their accuracy and precision have not recently been evaluated in a meta-analysis. We conducted a systematic search using PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science to review published data comparing CO measured by bolus thermodilution with commercially available non-invasive technologies including pulse wave transit time, non-invasive pulse contour analysis, thoracic electrical bioimpedance/bioreactance, and CO2 rebreathing. The non-invasive CO technology was considered acceptable if the pooled estimate of percentage error was <30%, as previously recommended. Using a random-effects model, sd, pooled mean bias, and mean percentage error were calculated. An I2 statistic was also used to evaluate the inter-study heterogeneity. A total of 37 studies (1543 patients) were included. Mean CO of both methods was 4.78 litres min−1. Bias was presented as the reference method minus the tested methods in 15 studies. Only six studies assessed the random error (repeatability) of the tested device. The overall random-effects pooled bias (limits of agreement) and the percentage error were −0,13 [−2.38 , 2.12] litres min−1 and 47%, respectively. Inter-study sensitivity heterogeneity was high (I2=83%, P<0.001). With a wide percentage error, completely non-invasive CO devices are not interchangeable with bolus thermodilution. Additional studies are warranted to demonstrate their role in improving the quality of care.

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

“…The funnel plot shows asymmetry min −1 and a MPE of 42.9% in adults, by a subgroup analysis including five EC studies and seven studies based on other algorithms [12]. Joosten et al performed a subgroup analysis including four EC studies and six studies based on other algorithms and found a bias of − 0.22 L min −1 and a MPE of 42% in adults [10]. These results are comparable with our findings.…”

“…The ICON ® and Aesculon ® monitors were included in three other meta-analyses [10][11][12]. Importantly, the data of the three other meta-analyses are the result of subgroup analyses for TEB, including EC but also other devices based on other algorithms.…”

“…When compared to other minimally or non-invasive techniques used in clinical practice, most devices show a MPE of more than 30% [10,12,[68][69][70][71][72][73][74][75][76]. Therefore, Peyton and Chong have suggested to change the acceptable MPE to 45%, ensuring a higher rate of agreement in new methods [12].…”

“…Several studies tried to validate EC using different reference methods, leading to conflicting results. EC was part of three meta-analyses with limited studies only [10][11][12]. So, its place between all existing hemodynamic monitoring devices has yet to be determined.…”

Journal of Clinical Monitoring and Computing 2018–2019 end of year summary: respiration

“…With prolonged hypercapnia, it was reported that EPBF maintains good agreement and trending with the reference cardiac output measurement (ultrasonic flow probe). EPBF, as a measure of the non-shunted blood flow through the lung, may be estimated by the application of the carbon dioxide Fick principle in a differential form using different perturbations, assumptions, algorithms and software-based correction factors [37,38].…”