Electrical Cardiometry: A Reliable Solution to Cardiac Output Estimation in Children With Structural Heart Disease
Jitin Narula1, Sandeep Chauhan1, Sivasubramanian Ramakrishnan2
1Department of Cardiac Anesthesiology, Cardio and Neuro Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Objective:
Comparison of cardiac output (CO) obtained using electric cardiometry (EC) and pulmonary artery catheterization (PAC) in pediatric patients with congenital structural heart disease.
Design:
Prospective, observational study.
Setting:
A tertiary hospital.
Participants:
The study comprised 50 patients scheduled to undergo cardiac catheterization.
Interventions:
CO data triplets were obtained simultaneously from the cardiometry device ICON (Osypka Medical, Berlin, Germany) and PAC at the following predefined time points-(1) T1: 5 minutes after arterial and venous cannulation and (2) T2: 5 minutes postprocedure; the average of the 3 readings was calculated. Reliability analysis and Bland-Altman analysis were performed to determine the limits of agreement, mean bias, and accuracy of the CO measured with EC.
Measurements And Main Results:
The measured EC-cardiac index 4.22 (3.84-4.60) L/min/m2 and PAC-cardiac index 4.26 (3.67-4.67) L/min/m2 were statistically insignificant (p value>0.05) at T1. Bland-Altman analysis revealed a mean bias of 0.0051 L/min/m2 and precision limits of±0.4927 L/min/m2. The intraclass correlation coefficient was 0.789 and Cronbach's alpha was 0.652, indicating good reproducibility and internal consistency between the two techniques. Postcatheterization analysis also revealed strong agreement and reliability between the two techniques.
Conclusions:
This study demonstrated that cardiac indices measured in children with a variety of structural heart diseases using EC reliably represent absolute values obtained using PAC. EC technology is simple and easy to use and offers noninvasive beat-to-beat tracking of CO and other hemodynamic parameters in children with structurally abnormal hearts.
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