Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study

Kuster, Matthias; Haltmeier, Tobias; Exadaktylos, Aristomenis K.; Schnüriger, Beat

doi:10.1007/s00068-018-0984-x

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…More recently, non-invasive cardiac output monitors are also being utilized to provide continuous data of patients’ hemodynamic status that could help in guiding fluid therapy and to predict FR ( 22 , 31 ). Several studies have demonstrated the usefulness of these non-invasive devices in adults ( 23 , 24 , 32 ), yet the effectiveness of such devices remains controversial in pediatric patients. Some studies support the use of these newer non-invasive techniques in children.…”

Section: Discussionmentioning

confidence: 99%

“…ICON monitor, which is based on a novel technology of electrical cardiometry (EC), is one such non-invasive hemodynamic monitoring device and has been studied for the assessment of FR in adult patients with the promising results ( 23 , 24 ). EC technique uses signals generated by the surface electrodes to measure the alterations in thoracic impedance.…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

et al. 2022

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IntroductionThe assessment of fluid responsiveness is important in the management of shock but conventional methods of assessing fluid responsiveness are often inaccurate. Our study aims to evaluate changes in objective hemodynamic parameters as measured using electrical cardiometry (ICON® monitor) following the fluid bolus in children presenting with shock and to evaluate whether any specific hemodynamic parameter can best predict fluid responsiveness among children with shock.Materials and MethodsWe conducted a prospective observational study in children presenting with shock to our emergency department between June 2020 and March 2021. We collected the parameters such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and hemodynamic data such as cardiac output CO), cardiac index (CI), index of contractility (ICON), stroke volume (SV), stroke index (SI), corrected flow time (FTC), systolic time ratio (STR), variation of index of contractility (VIC), stroke volume variation (SVV), systemic vascular resistance (SVR), and thoracic fluid content (TFC) using the ICON monitor before and after fluid bolus (FB). We assessed percent change (Δ) and used paired-sample Student’s t-test to compare pre- and post-hemodynamic data and Mann–Whitney U-test to compare fluid responders and non-responders. P-Values < 0.05 were considered statistically significant.ResultsWe recorded 42 fluid interventions in 40 patients during our study period. The median IQR age was 10.56 (4.8, 14.8) years with male/female ratio (1.2:1). There was a significant decrease in ΔRR [−1.61 (−14.8, 0); p = 0.012], ΔDBP [−5.5 (−14.4, 8); p = 0.027], ΔMAP [−2.2 (−11, 2); p = 0.018], ΔSVR [−5.8 (−20, 5.2); p = 0.025], and ΔSTR [−8.39 (−21, 3); p = 0.001] and significant increase in ΔTFC [6.2 (3.5, 11.4); p = 0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single FB of 20 ml/kg crystalloid. Receiver operating curve analysis revealed that among all the parameters, 15% change in ICON had an excellent AUC (0.85) for the fluid responsiveness.ConclusionOur study showed significant changes in objective hemodynamic parameters, such as SVR, STR, and TFC following FB in children presenting with shock. A 15% change in ICON had an excellent predictive performance for the fluid responsiveness among our cohort of pediatric shock.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

et al. 2022

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“…The EC signal is very sensitive to interference, leading to inaccurate measurements [ 12 ]. The changes in conductivity created by the circulatory system measured by the two inner electrodes are very small.…”

Section: Discussionmentioning

confidence: 99%

“…It is a robust and portable handheld device, and may be perfectly suited for the use in prehospital care. Recently it was used in the initial hemodynamic evaluation of trauma patients in the emergency department [ 12 ]. The device has its own internal quality score to assess the quality of the measured signal.…”

Section: Purposementioning

confidence: 99%

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Non-invasive electrical cardiometry cardiac output monitoring during prehospital helicopter emergency medical care: a feasibility study

Slagt

Servaas

Ketelaars

et al. 2021

J Clin Monit Comput

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Purpose Introducing advanced hemodynamic monitoring might be beneficial during Helicopter Emergency Medical Service (HEMS) care. However, it should not increase the on-scene-time, it should be easy to use and should be non-invasive. The goal of this study was to investigate the feasibility of non-invasive cardiac output measurements by electrical cardiometry (EC) and the quality of the EC signal during pre-hospital care provided by our HEMS. Methods A convenience sample of fifty patients who required HEMS assistance were included in this study. Problems with respect to connecting the patient, entering patient characteristics and measuring were inventoried. Quality of EC signal of the measurements was assessed during prehospital helicopter care. We recorded the number of measurements with a signal quality indicator (SQI) ≥ 80 and the number of patients having at least 1 measurement with a SQI ≥ 80. Furthermore, the SQI value distribution of the measurements within each patient was analysed. Results In the experience of the attending HEMS caregivers application of the device was easy and did not result in increased duration of on-scene time. Patch adhesion was reported as a concern due to clammy skin in 22% of all cases. 684 measurements were recorded during HEMS care. In 47 (94%) patients at least 1 measurement with an SQI ≥ 80 was registered. Of all recorded measurements 5.8% had an SQI < 40, 11.4% had an SQI 40–59, 14.9% had a SQI between 60 and 79 and 67.8% had SQI ≥ 80. Conclusion Cardiac output measurements are feasible during prehospital HEMS care with good quality of the EC signal. Monitoring was easy to use and quick to install. In our view it is an promising candidate for the prehospital setting. Further research is needed to determine its clinical value during clinical decision making.

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Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

Pham,

Shah,

Chandran

et al. 2023

J Pediatr Intensive Care

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Passive leg raise (PLR) is widely used to incite an autobolus to assess fluid responsiveness in adults; however, there is a paucity of studies exploring its utility in children. Our study aimed to analyze the efficacy of PLR in determining fluid responsiveness in children presenting with shock using electrical cardiometry. Patients in the age group of 0 to 20 years who presented in shock to our children's hospital emergency department were evaluated. Multiple hemodynamic metrics including, heart rate, systolic/diastolic blood pressure, cardiac output (CO), stroke index, stroke volume (SV), flow time corrected (FTC), and left ventricular ejection time (LVET) were recorded using the noninvasive ICON device and compared at baseline and post-PLR. A total of 68 patients had pre- and post-PLR data available for review between June and July 2022. Median age was 7 years (54% male); most common etiology was hypovolemic (67.6%) shock. Following PLR, there was no significant change in most hemodynamic parameters, including SV and CO; however, there was a significant difference in FTC (301 [pre-PLR] vs. 307 [post-PLR], p = 0.016) (ms) and LVET (232 [pre-PLR] vs. 234 [post-PLR], p = 0.014) (ms). A significantly higher proportion of children diagnosed with septic shock demonstrated fluid responsiveness (ΔSV ≥ 10% from baseline) compared with those with hypovolemic shock (p = 0.036). This study demonstrated no identifiable fluid responsiveness (ΔSV ≥ 10% from baseline) following PLR; however, a significantly higher proportion of children suffering from septic shock demonstrated fluid responsiveness compared with those with hypovolemic shock. Larger studies are needed to further assess the utility of PLR, as well as other modalities, in determining fluid responsiveness in children.

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Non-invasive cardiac output monitoring device “ICON” in trauma patients: a feasibility study

Cited by 5 publications

References 23 publications

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

Non-invasive Cardiac Output Monitoring and Assessment of Fluid Responsiveness in Children With Shock in the Emergency Department

Non-invasive electrical cardiometry cardiac output monitoring during prehospital helicopter emergency medical care: a feasibility study

Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

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