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Transoesophageal echocardiography accurately detects cardiac output variation: a prospective comparison with thermodilution in cardiac surgery

Published online by Cambridge University Press:  01 February 2008

V. Parra ,
G. Fita ,
I. Rovira ,
P. Matute ,
C. Gomar  and
C. Paré
V. Parra*
Affiliation:
Universidad de Chile, Hospital Clínico y Facultad de Medicina, Anestesiología, Santiago, Chile
G. Fita
Affiliation:
Universidad de Barcelona, Hospital Clínic, Anestesiología, Spain
I. Rovira
Affiliation:
Universidad de Barcelona, Hospital Clínic, Anestesiología, Spain
P. Matute
Affiliation:
Universidad de Barcelona, Hospital Clínic, Anestesiología, Spain
C. Gomar
Affiliation:
Universidad de Barcelona, Hospital Clínic, Anestesiología, Spain
C. Paré
Affiliation:
Universidad de Barcelona, Hospital Clínic, Unidad de Ecocardiografía, Cardiología, Spain
*
Correspondence to: Victor Parra, Instituto de Ciencias Biomédicas, Facultad de Medicina Universidad de Chile, Casilla 16038, Avenida Salvador 486 (Providencia), Santiago 9, Chile. E-mail: vparra@med.uchile.cl; Tel: +56 2 2741560; Fax: +56 2 2741628
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Summary

Background and objective

Intraoperative Doppler ultrasound can be used to measure cardiac output by transoesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surgery. We also assessed the agreement between the techniques.

Methods

Fifty cardiac surgical patients (38 male, 12 female, mean age of 63.4 ± 14.3 yr) were prospectively included after approval by the Ethics Committee of the Institution. Cardiac output was assessed by thermodilution, with 10 mL saline at 12°C, and simultaneously and blindly by echo-Doppler in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract. Matched thermodilution cardiac output and echo-Doppler cardiac output measurements were taken three times at the end of expiration, both pre- and post-cardiopulmonary bypass.

Results

Echo-Doppler measurements were obtained in 44 patients (88%). In three patients, Doppler recordings could not be obtained adequately, and three developed left ventricular outflow tract obstruction after bypass. Bland–Altman analysis revealed a bias of 0.015 L min−1, with narrow limits of agreement (−1.21 to 1.22 L min−1) and 29.1% error. Echo-Doppler was accurate (92% sensitivity and 71% specificity, P = 0.008 by receiver operating characteristic curves) for detecting more than 10% of change in thermodilution cardiac output. There were no complications related to the study.

Conclusions

The agreement between cardiac output by echo-Doppler and by thermodilution is clinically acceptable and transoesophageal echocardiography is a reliable tool to assess significant cardiac output changes in a population of selected patients.

Keywords

CARDIAC OUTPUTTHERMODILUTIONCATHETERIZATION SWAN GANZECHOCARDIOGRAPHY DOPPLERCARDIAC SURGICAL PROCEDURES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 2 , February 2008 , pp. 135 - 143
Copyright
Copyright © European Society of Anaesthesiology 2007

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