Systematic review of cardiac output measurements by echocardiography vs. thermodilution: the techniques are not interchangeable

Wetterslev, Mik; Møller‐Sørensen, Hasse; Johansen, R. R.; Perner, Anders

doi:10.1007/s00134-016-4258-y

Cited by 99 publications

(70 citation statements)

References 64 publications

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“…Either transthoracic or transoesophageal echocardiography may be used to estimate cardiac output. However, few studies have validated the accuracy of echocardiography compared to the ‘gold standard’ pulmonary artery catheter (PAC) . One recent study in 38 mechanically ventilated patients found high correlation (r=0.95) between cardiac output measured by PAC and cardiac output measured by transthoracic echocardiography .…”

Section: Imagingmentioning

confidence: 99%

“…One recent study in 38 mechanically ventilated patients found high correlation (r=0.95) between cardiac output measured by PAC and cardiac output measured by transthoracic echocardiography . The techniques are not interchangeable when measuring cardiac output, but they may be interchangeable to follow directional changes in cardiac output …”

Section: Imagingmentioning

confidence: 99%

“…115 The techniques are not interchangeable when measuring cardiac output, but they may be interchangeable to follow directional changes in cardiac output. 114 Echocardiography has been strongly recommended by consensus groups in patients presenting with circulatory failure. 116,117 It should be noted that echocardiography allows performance of the full haemodynamic evaluation, including chamber volumes, systolic and diastolic function, and heart-lung interactions, filling pressure, and cardiac output.…”

Section: Echocardiography For Monitoring Cardiac Outputmentioning

confidence: 99%

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Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Harjola

Parissis

Rocca

et al. 2018

European J of Heart Fail

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This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.

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Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Echocardiography For Monitoring Cardiac Outputmentioning

confidence: 99%

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Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Harjola

Parissis

Rocca

et al. 2018

European J of Heart Fail

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“…In the critical care setting, few studies have evaluated the level of concordance between CO estimated by TTE (CO-TTE) and CO estimated by PAC (CO-PAC) [4–6]. In these studies, Bland–Altman analyses have evidenced a small level of bias and a broad limit of agreement (LOA).…”

Section: Introductionmentioning

confidence: 99%

Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient

et al. 2017

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BackgroundCardiac output (CO) monitoring is a valuable tool for the diagnosis and management of critically ill patients. In the critical care setting, few studies have evaluated the level of agreement between CO estimated by transthoracic echocardiography (CO-TTE) and that measured by the reference method, pulmonary artery catheter (CO-PAC). The objective of the present study was to evaluate the precision and accuracy of CO-TTE relative to CO-PAC and the ability of transthoracic echocardiography to track variations in CO, in critically ill mechanically ventilated patients.MethodsThirty-eight mechanically ventilated patients fitted with a PAC were included in a prospective observational study performed in a 16-bed university hospital ICU. CO-PAC was measured via intermittent thermodilution. Simultaneously, a second investigator used standard-view TTE to estimate CO-TTE as the product of stroke volume and the heart rate obtained during the measurement of the subaortic velocity time integral.ResultsSixty-four pairs of CO-PAC and CO-TTE measurements were compared. The two measurements were significantly correlated (r = 0.95; p < 0.0001). The median bias was 0.2 L/min, the limits of agreement (LOAs) were –1.3 and 1.8 L/min, and the percentage error was 25%. The precision was 8% for CO-PAC and 9% for CO-TTE. Twenty-six pairs of ΔCO measurements were compared. There was a significant correlation between ΔCO-PAC and ΔCO-TTE (r = 0.92; p < 0.0001). The median bias was –0.1 L/min and the LOAs were –1.3 and +1.2 L/min. With a 15% exclusion zone, the four-quadrant plot had a concordance rate of 94%. With a 0.5 L/min exclusion zone, the polar plot had a mean polar angle of 1.0° and a percentage error LOAs of –26.8 to 28.8°. The concordance rate was 100% between 30 and –30°. When using CO-TTE to detect an increase in ΔCO-PAC of more than 10%, the area under the receiving operating characteristic curve (95% CI) was 0.82 (0.62–0.94) (p < 0.001). A ΔCO-TTE of more than 8% yielded a sensitivity of 88% and specificity of 66% for detecting a ΔCO-PAC of more than 10%.ConclusionIn critically ill mechanically ventilated patients, CO-TTE is an accurate and precise method for estimating CO. Furthermore, CO-TTE can accurately track variations in CO.

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“…However, other methods have not been properly validated for monitoring, e.g. cardiac output measurements by echocardiography [14]. Taken together, there is no high-quality evidence indicating improved patient care and outcomes with the use of any haemodynamic tool in critically ill patients.…”

Section: Why Are the Advanced Haemodynamic Tools Not Used To Guide Flmentioning

confidence: 99%

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2017

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Systematic review of cardiac output measurements by echocardiography vs. thermodilution: the techniques are not interchangeable

Cited by 99 publications

References 64 publications

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Comprehensive in‐hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient

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