Validation of a new method based on ultrasound velocity dilution to measure cardiac output in paediatric patients

• Published in: Intensive care medicine Vol. 39; no. 5; pp. 926 - 933
• Main Authors: Floh, Alejandro A., La Rotta, Gustavo, Wermelt, Julius Z., Bastero-Miñón, Patricia, Sivarajan, V. Ben, Humpl, Tilman
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-05-2013; Springer; Springer Nature B.V
• Subjects: Age; Analysis; Anesthesiology; Arterial lines; Blood Flow Velocity; Cardiac Output - physiology; Cardiac patients; Cardiovascular disease; Catheters; Congenital diseases; Congenital heart disease; Critical care; Critical Care Medicine; Emergency Medicine; Equipment Design; Female; Genetic disorders; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart diseases; Heart Function Tests; Humans; Indicator Dilution Techniques - instrumentation; Infant; Infant, Newborn; Intensive; Male; Mass Spectrometry; Measurement; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Methods; Oxygen Consumption - physiology; Oxygen saturation; Pain Medicine; Pediatric Original; Pediatrics; Physiology; Pneumology/Respiratory System; Prospective Studies; Scientific imaging; Ultrasonic imaging; Ultrasonography; Velocity; New York; Denmark; Children; Cardiac surgery; Cardiac output; Ultrasound dilution; Monitoring
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-013-2848-5

Purpose
To validate a novel method of ultrasound dilution (COstatus
®
; Transonic Systems, Ithaca, NY) for measuring cardiac output in paediatric patients after biventricular repair of congenital heart disease.
Methods
Children undergoing biventricular repair of congenital heart disease were prospectively identified. Patients with significant intracardiac shunts were excluded. Postoperative cardiac output was measured by ultrasound dilution (COud) and concurrently calculated by the Fick equation (COrms) using measured oxygen consumption by respiratory mass spectrometry.
Results
Thirty-five patients were studied generating 66 individual data sets. Subjects had a median (interquartile range) age of 147 days (11, 216), weight of 4.98 kg (3.78, 6.90) and body surface area of 0.28 m
2
(0.22, 0.34). Of the patients, 66 % had peripheral arterial catheters and 34 % had femoral cannulation; peripheral arterial lines accounted for 6/8 of unsuccessful studies due to inability to generate sufficient flow. The site of the central venous cannula did not impact the feasibility of completing the study. A mean bias of 0.00 L/min [2 standard deviation (SD) ± 0.76 L/min] between COud and COrms was found with a percentage error of 97 %. When comparing cardiac index, bias increased to 0.13 L/min/m
2
(2SD ± 2.16 L/min/m
2
).
Conclusions
Cardiac output by ultrasound dilution showed low bias with wide limits of agreement when compared to measurement derived by the Fick equation. Although measurements through central and peripheral arterial lines were completed with minimal difficulties in the majority of patients, the application of COstatus
®
in neonates with low body surface area may be limited.