Noninvasive Cardiac Output Monitoring Using Electrical Cardiometry and Outcomes in Critically Ill Children

Area of Science:

• Pediatric Critical Care Medicine
• Hemodynamic Monitoring
• Noninvasive Cardiovascular Assessment

Background:

• Accurate cardiac output (CO) measurement is vital for hemodynamic assessment in critically ill children.
• Existing CO measurement methods in pediatric intensive care units (PICUs) are often invasive, difficult, or inaccurate.
• Limited research exists on the utility of noninvasive electrical cardiometry (EC) for CO assessment and outcome prediction in critically ill children.

Purpose of the Study:

• To evaluate cardiac output (CO) measured by noninvasive electrical cardiometry (EC) as a predictor of outcomes in critically ill children.
• To compare CO measurements obtained via EC with those from transthoracic echocardiography (TTE).
• To analyze the correlation between EC-derived CO and clinical outcomes such as ventilator days, PICU length of stay, and mortality.

Main Methods:

• Retrospective chart review of critically ill children (<21 years) admitted to the PICU with acute respiratory failure and/or shock.
• Data collection included demographic information, CO measurements via EC (ICON monitor) and TTE, ventilator days, PICU/hospital days, inotrope score, and mortality.
• Statistical analysis employed Chi-square and multiple linear regression to assess correlations and predictive values.

Main Results:

• 327 EC CO recordings from 61 children were analyzed; median CO values were reported.
• Electrical cardiometry (EC) derived CO did not show significant correlation with transthoracic echocardiography (TTE) measurements (p=0.9).
• Both nadir and median EC-derived CO significantly predicted ventilator days (p=0.05 and p=0.01, respectively); nadir CO correlated with peak inotrope score (r=-0.3).

Conclusions:

• In critically ill children with respiratory failure or shock, EC-derived CO did not correlate with TTE.
• Despite the lack of correlation with TTE, both nadir and median CO measured by EC demonstrated predictive value for clinical outcomes.
• Electrical cardiometry represents a potentially valuable noninvasive tool for monitoring critically ill pediatric patients and predicting outcomes.