A comparison of cardiac output by thoracic impedance and direct fick in children with congenital heart disease undergoing diagnostic cardiac catheterization

Katherine Taylor, Gustavo La Rotta, Brian W. McCrindle, Cedric Manlhiot, Andrew Redington, Helen Holtby

Research output: Contribution to journalArticlepeer-review

Abstract

Objective(s): To evaluate the measurement of cardiac output (CO) using continuous electrical bioimpedance cardiography (Physioflow; Neumedx, Philadelphia, PA) (CO PF) with a simultaneous direct Fick measurement (CO FICK) in children with congenital heart disease. Design: A prospective cohort study comparing 2 methods of measurement of CO. Setting: A quaternary university-affiliated pediatric hospital. Participants: Children undergoing cardiac catheterization for clinical care. Interventions: The Physioflow measured continuous real time CO in 15-second epochs and simultaneous measurement of cardiac output by direct Fick (with mass spectrometry to assess VO 2) were acquired. Measurements and Main Results: Sixty-five patients were recruited, and data from 56 (25 males) were adequate for analysis. The median age at study was 3.5 years (range, 0.4-16.6 years), and the median body surface area was 0.62 m 2 (range, 0.31-1.71). There were 25 of 56 (45%) with univentricular physiology. A total of 19,228 Physioflow data points were available for the analysis of which 14,569 (76%) were valid; 96% of the invalid measurements were identified as artifacts by the device. The average cardiac index of valid measurements was 3.09 ± 0.72 L/min/m 2. Compared with the Fick CO, the mean bias was -0.09 L/min, but the 95% limits of agreement were -3.20 to +3.01 L/min/m 2. Consequently, only 20 of 56 (36%) of measurements were within 20%, and 31 of 56 (55%) of measurements were within 30% of each other. Conclusions: Compared with measurements made by direct Fick, CO measured using the Physioflow device was unreliable in anesthetized children with congenital heart disease.

Original languageEnglish (US)
Pages (from-to)776-779
Number of pages4
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume25
Issue number5
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

Keywords

  • Fick technique
  • cardiac output
  • congenital heart disease
  • pediatrics
  • thoracic impedance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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