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Comparison Between Doppler-Echocardiography and Uncalibrated Pulse Contour Method for Cardiac Output Measurement: A
Sabino Scolletta1, Federico Franchi, Stefano Romagnoli
11Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Siena, Italy. 2Department of Anesthesiology and Critical Care, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy. 3Department of Health Science, University of Florence, Florence, Italy. 4Department of Emergency and Critical Medicine, Anesthesiology and Intensive Care, Mugello Hospital, Florence, Italy. 5Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Clinica di Anestesia e Rianimazione, Torrette di Ancona, Italy. 6Dipartimento di Emergenza-Urgenza, Azienda Sanitaria Massa Carrara, Ospedale di Pontremoli, Pontremoli, Italy. 7Department of Surgery, Intensive Care Unit IV, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 8Department of Anesthesia and Surgical Critical Care, Hospital Universitari i Politécnic La Fe, Valencia, Spain. 9Department of Emergency and Critical Medicine, Anesthesiology and Intensive Care, Santa Maria Annunziata Hospital, Florence, Italy. 10Department of Emergency and Critical Medicine, Anesthesiology and Intensive Care, San Giovanni di Dio Hospital, Florence, Italy. 11Department of Cardiothoracic Anesthesia and Intensive Care, San Raffaele Hospital, Istituto Scientifico San Raffaele, Milan, Italy. 12Department of Anaesthesia, Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. 13Department of Anesthesiology and Intensive Care, University of Foggia, Foggia, Italy. 14Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University of Rome "La Sapienza," Rome, Italy. 15Emergency Department, Istituto di Anestesia e Rianimazione, Azienda Ospedaliera Universitaria di Padova, Padova, Italy. 16Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris and UMR INSERM 1160: Alloimmunité, Autoimmunité, Transpla
Insights
The pulse contour method MostCare effectively estimates cardiac output in critically ill patients, offering a viable alternative to echocardiography. This study compared MostCare with echocardiography in 400 ICU patients, finding a significant correlation and acceptable error margins.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Medical Technology Assessment
Background:
- Cardiac output (CO) monitoring is crucial in intensive care units (ICUs).
- Echocardiography provides noninvasive CO estimation, while pulse contour analysis offers a less invasive approach.
- Comparing different CO monitoring methods is essential for clinical practice optimization.
Purpose of the Study:
- To compare the accuracy of the pulse contour method (MostCare) with Doppler echocardiography for cardiac output estimation.
- To evaluate MostCare's performance in a large, unselected population of critically ill patients across various clinical conditions.
Main Methods:
- A prospective, multicenter observational study involving 400 critically ill patients in 15 European ICUs.
- Cardiac output was measured using both Doppler echocardiography and the MostCare system.
- Statistical analyses included Bland-Altman and linear regression to assess agreement and correlation.
Main Results:
- A significant correlation (r = 0.85, p < 0.0001) was observed between MostCare and echocardiography CO measurements.
- The overall mean bias was -0.03 L/min with 95% limits of agreement of -1.54 to 1.47 L/min.
- The overall percentage error was 27.3%, with lower errors noted in sepsis (24%) and trauma (26%) patient categories.
Conclusions:
- The MostCare system demonstrates potential as a reliable alternative to echocardiography for cardiac output assessment in diverse ICU patient populations.
- The findings support the integration of pulse contour analysis for continuous and less invasive hemodynamic monitoring in critical care settings.
Objectives:
Echocardiography and pulse contour methods allow, respectively, noninvasive and less invasive cardiac output estimation. The aim of the present study was to compare Doppler echocardiography with the pulse contour method MostCare for cardiac output estimation in a large and nonselected critically ill population.
Design:
A prospective multicenter observational comparison study.
Setting:
The study was conducted in 15 European medicosurgical ICUs.
Patients:
We assessed cardiac output in 400 patients in whom an echocardiographic evaluation was performed as a routine need or for cardiocirculatory assessment.
Interventions:
None.
Measurements And Main Results:
One echocardiographic cardiac output measurement was compared with the corresponding MostCare cardiac output value per patient, considering different ICU admission categories and clinical conditions. For statistical analysis, we used Bland-Altman and linear regression analyses. To assess heterogeneity in results of individual centers, Cochran Q, and the I statistics were applied. A total of 400 paired echocardiographic cardiac output and MostCare cardiac output measures were compared. MostCare cardiac output values ranged from 1.95 to 9.90 L/min, and echocardiographic cardiac output ranged from 1.82 to 9.75 L/min. A significant correlation was found between echocardiographic cardiac output and MostCare cardiac output (r = 0.85; p < 0.0001). Among the different ICUs, the mean bias between echocardiographic cardiac output and MostCare cardiac output ranged from -0.40 to 0.45 L/min, and the percentage error ranged from 13.2% to 47.2%. Overall, the mean bias was -0.03 L/min, with 95% limits of agreement of -1.54 to 1.47 L/min and a relative percentage error of 30.1%. The percentage error was 24% in the sepsis category, 26% in the trauma category, 30% in the surgical category, and 33% in the medical admission category. The final overall percentage error was 27.3% with a 95% CI of 22.2-32.4%.
Conclusions:
Our results suggest that MostCare could be an alternative to echocardiography to assess cardiac output in ICU patients with a large spectrum of clinical conditions.
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