Cardiac output measurements via echocardiography versus thermodilution: A systematic review and meta-analysis

• Published in: PloS one Vol. 14; no. 10; p. e0222105
• Main Authors: Zhang, Yun, Wang, Yan, Shi, Jing, Hua, Zhiqiang, Xu, Jinyu
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03-10-2019; Public Library of Science (PLoS)
• Subjects: Analysis; Aorta; Bias; Biology and Life Sciences; Cardiac function; Cardiac output; Cardiac Output - physiology; Cardiac patients; Catheters; Clinical trials; Confidence intervals; Correlation coefficient; Correlation coefficients; Critically ill persons; Diagnostic systems; Echocardiography; Echocardiography, Doppler; Emergency medical care; Health aspects; Heart; Heart failure; Heart rate; Hemodynamics; Hospitals; Humans; Intensive care; Liver; Measurement techniques; Medical instruments; Medical research; Medicine; Medicine and Health Sciences; Meta-analysis; Methods; Patients; Physical Sciences; Publication Bias; Pulmonary arteries; Pulmonary artery; Quality assessment; Quality control; Regression Analysis; Research and Analysis Methods; Risk; Studies; Subgroups; Systematic review; Thermodilution; Ultrasonic imaging; Ultrasonic methods; Ultrasonic testing; Veins & arteries; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222105

Echocardiography, as a noninvasive hemodynamic evaluation technique, is frequently used in critically ill patients. Different opinions exist regarding whether it can be interchanged with traditional invasive means, such as the pulmonary artery catheter thermodilution (TD) technique. This systematic review aimed to analyze the consistency and interchangeability of cardiac output measurements by ultrasound (US) and TD. Five electronic databases were searched for studies including clinical trials conducted up to June 2019 in which patients' cardiac output was measured by ultrasound techniques (echocardiography) and TD. The methodological quality of the included studies was evaluated by two independent reviewers who used the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), which was tailored according to our systematic review in Review Manager 5.3. A total of 68 studies with 1996 patients were identified as eligible. Meta-analysis and subgroup analysis were used to compare the cardiac output (CO) measured using the different types of echocardiography and different sites of Doppler use with TD. No significant differences were found between US and TD (random effects model: mean difference [MD], -0.14; 95% confidence interval, -0.30 to 0.02; P = 0.08). No significant differences were observed in the subgroup analyses using different types of echocardiography and different sites except for ascending aorta (AA) (random effects model: mean difference [MD], -0.37; 95% confidence interval, -0.74 to -0.01; P = 0.05) of Doppler use. The median of bias and limits of agreement were -0.12 and ±0.94 L/min, respectively; the median of correlation coefficient was 0.827 (range, 0.140-0.998). Although the difference in CO between echocardiography by different types or sites and TD was not entirely consistent, the overall effect of meta-analysis showed that no significant differences were observed between US and TD. The techniques may be interchangeable under certain conditions.