Non-invasive cardiac output monitor validation study in pediatric cardiac surgery patients

Tirotta, Christopher F.; Lagueruela, Richard G.; Madril, Danielle; Velis, Evelio; Ojito, Jorge; Monroe, Daniel; Aguero, David; Irizarry, Marysory; McBride, J.W.; Hannan, Robert L.; Burke, Redmond P.

doi:10.1016/j.jclinane.2017.02.001

Cited by 14 publications

(22 citation statements)

References 30 publications

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“…Two of 29 studies calculated the "true precision" (TP) of TEV (taking into account the PE of the comparator): TP was close to 30%; however, one study concluded clinical acceptability, (37), whereas the other did not (24). One study reported clinical acceptability based on correlation alone (44) and another based on the ability of TEV to guide fluid management intraoperatively (35).…”

Section: Resultsmentioning

confidence: 99%

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Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis*

Mansfield

Kaza

Charalambous

et al. 2021

Critical Care Medicine

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To systematically review and meta-analyze the validity of electrical bioimpedance-based noninvasive cardiac output monitoring in pediatrics compared with standard methods such as thermodilution and echocardiography.DATA SOURCES: Systematic searches were conducted in MEDLINE and EMBASE (2000-2019). STUDY SELECTION:Method-comparison studies of transthoracic electrical velocimetry or whole body electrical bioimpedance versus standard cardiac output monitoring methods in children (0-18 yr old) were included. DATA EXTRACTION:Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Mean differences of cardiac output, stroke volume, or cardiac index measurements were pooled using a randomeffects model (R Core Team, R Foundation for Statistical Computing, Vienna, Austria, 2019). Bland-Altman statistics assessing agreement between devices and author conclusions about inferiority/noninferiority were extracted.DATA SYNTHESIS: Twenty-nine of 649 identified studies were included in the qualitative analysis, and 25 studies in the meta-analyses. No significant difference was found between means of cardiac output, stroke volume, and cardiac index measurements, except in exclusively neonatal/infant studies reporting stroke volume (mean difference, 1.00 mL; 95% CI, 0.23-1.77). Median percentage error in child/adolescent studies approached acceptability (percentage error less than or equal to 30%) for cardiac output in L/min (31%; range, 13-158%) and stroke volume in mL (26%; range, 14-27%), but not in neonatal/infant studies (45%; range, 29-53% and 45%; range, 28-70%, respectively). Twenty of 29 studies concluded that transthoracic electrical velocimetry/whole body electrical bioimpedance was noninferior. Transthoracic electrical velocimetry was considered inferior in six of nine studies with heterogeneous congenital heart disease populations. CONCLUSIONS:The meta-analyses demonstrated no significant difference between means of compared devices (except in neonatal stroke volume studies). The wide range of percentage error reported may be due to heterogeneity of study designs, devices, and populations included. Transthoracic electrical velocimetry/ whole body electrical bioimpedance may be acceptable for use in child/adolescent populations, but validity in neonates and congenital heart disease patients remains uncertain. Larger studies in specific clinical contexts with standardized methodologies are required.

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Section: Resultsmentioning

confidence: 99%

“…Eleven studies recruited only patients with congenital heart diseases (CHDs) (20,30,34,36,38,40,(42)(43)(44)(45)(46). Two of these included patients with a single cardiac pathology without shunts and showed good agreement between methods (20,30).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis*

Mansfield

Kaza

Charalambous

et al. 2021

Critical Care Medicine

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“…After title and abstract screening, 41 studies remained. Those full-text articles were assessed for eligibility, which led to 24 included studies and 17 excluded studies [18,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67]. The included studies were divided into 13 studies in adults [28][29][30][31][32][33][34][35][36][37][38][39][40] and 11 studies in pediatrics [41][42][43][44][45][46][47][48][49][50][51].…”

Section: Study Selectionmentioning

confidence: 99%

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

Sanders

Servaas

Slagt

2019

J Clin Monit Comput

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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.

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“…On the other side of the spectrum, newer noninvasive hemodynamic monitoring modalities such as electrical cardiometry, impedance cardiography, and bioreactance have been described and tested in pediatric populations but again, real life implementation has been scarce at best. [6][7][8][9] Overall, very few commercially available cardiac output monitoring devices are applicable in pediatric patients, and most of them present with incomplete validations and/or poor precision and accuracy. 9 So why has this important topic not made it to "prime time" in the pediatric anesthesia community?…”

Section: Babies and Children At Lastmentioning

confidence: 99%

Babies and Children at Last

2019

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Non-invasive cardiac output monitor validation study in pediatric cardiac surgery patients

Cited by 14 publications

References 30 publications

Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis*

Cardiac Output Measurement in Neonates and Children Using Noninvasive Electrical Bioimpedance Compared With Standard Methods: A Systematic Review and Meta-Analysis*

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

Babies and Children at Last

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