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Published on: January 27, 2023
A randomized controlled trial of electrical cardiometry-guided perioperative hemodynamic management in children
Rohan S Thottan1, Sambhunath Das1, Neeti Makhija1
1Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Electrical cardiometry (EC) guided management improved hemodynamic stability and metabolic recovery in pediatric patients undergoing congenital heart disease (CHD) surgery. This noninvasive approach offers a valuable adjunct to conventional monitoring for better early postoperative outcomes.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Biomedical Engineering
Background:
- Children with congenital heart disease (CHD) face risks of hemodynamic instability and low cardiac output syndrome (LCOS) during corrective surgery.
- Conventional monitoring methods may not accurately reflect real-time cardiac function.
- Electrical cardiometry (EC) offers continuous, noninvasive assessment of cardiac output and related hemodynamic indices.
Purpose of the Study:
- To evaluate if EC-guided perioperative management improves early postoperative outcomes in pediatric CHD surgery compared to conventional monitoring.
- To assess the efficacy of EC in guiding fluid and vasoactive therapy.
Main Methods:
- A prospective randomized controlled trial involving 60 children (0-15 years) undergoing elective corrective CHD surgery.
- Group 1 (n=30) received EC-guided management using cardiac index (CI), stroke volume, thoracic fluid content, and stroke volume variation.
- Group 2 (n=30) received conventional monitoring. Primary outcome was LCOS incidence within 48 hours.
Main Results:
- EC-guided management resulted in significantly higher mean arterial pressure (MAP) at 8, 16, and 24 hours postoperatively.
- Faster lactate clearance and lower vasoactive inotropic score (VIS) were observed in the EC-guided group.
- Cardiac index (CI) showed positive correlation with MAP and urine output, and inverse correlation with lactate levels.
Conclusions:
- EC-guided perioperative management enhances early postoperative hemodynamic stability and metabolic recovery in pediatric CHD surgery.
- EC serves as a valuable noninvasive tool, complementing conventional monitoring strategies.
- The study demonstrated no in-hospital mortality in either group.
Background And Aims:
Children undergoing corrective surgery for congenital heart disease (CHD) are at risk of perioperative hemodynamic instability and low cardiac output syndrome (LCOS). Conventional monitoring relies on static parameters that may inadequately reflect real-time cardiac performance. Electrical cardiometry (EC) provides continuous, noninvasive assessment of cardiac output and related indices. This study evaluated whether EC-guided perioperative management improves early postoperative outcomes compared with conventional monitoring in pediatric CHD surgery.
Methods:
In this prospective randomized controlled trial, 60 children (0-15 years) undergoing elective corrective CHD surgery were randomized to EC-guided management (Group 1, n = 30) or conventional monitoring (Group 2, n = 30). In Group 1, perioperative fluid and vasoactive therapy were guided by EC-derived parameters, including cardiac index (CI), stroke volume, thoracic fluid content, and stroke volume variation. Group 2 was managed using standard clinical and invasive parameters. The primary outcome was the incidence of LCOS within 48 h postoperatively. The secondary outcomes included vasoactive inotropic score (VIS), major adverse cardiac events, and in-hospital mortality.
Results:
Baseline characteristics were comparable. Group 1 demonstrated significantly higher mean arterial pressure (MAP) at 8, 16, and 24 h postoperatively, faster lactate clearance, and lower VIS during the early postoperative period. CI correlated positively with MAP and urine output and inversely with lactate levels. No mortality occurred.
Conclusions:
EC-guided perioperative management aids in achieving early postoperative hemodynamic stability and metabolic recovery in children undergoing corrective CHD surgery and represents a valuable noninvasive adjunct to conventional monitoring.
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