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. 2014 Nov 12;18(2):127-33.
doi: 10.1007/s40477-014-0139-9. eCollection 2015 Jun.

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

Marika Gassner  1 , Keith Killu  1 , Zachary Bauman  1 , Victor Coba  1 , Kelly Rosso  1 , Dionne Blyden  1
Affiliations

Feasibility of common carotid artery point of care ultrasound in cardiac output measurements compared to invasive methods

Marika Gassner et al. J Ultrasound. .

Abstract
in English, Italian

Background: Cardiac output (CO) measurement in the intensive care unit (ICU) requires invasive devices such as the pulmonary artery (PA) catheter or arterial waveform pulse contour analysis (PCA). This study tests the accuracy and feasibility of point of care ultrasound (POCUS) of the common carotid artery to estimate the CO non-invasively and compare it to existing invasive CO measurement modalities.

Methods: Patients admitted to the surgical and cardiothoracic ICU in a tertiary university-affiliated academic center during a 4-month period, with invasive hemodynamic monitoring devices for management, were included in this cohort study. Common carotid artery POCUS was performed to measure the CO and the results were compared to an invasive device.

Results: Intensivists and ICU fellows, using ultrasound of the common carotid artery, obtained the CO measurements. Images of the Doppler flow and volume were obtained at the level of the thyroid gland. Concurrent CO measured via invasive devices was recorded. The patient cohort comprised 36 patients; 52 % were females. The average age was 59 ± 13 years, and 66 % were monitored via PCA device and 33 % via PA catheter. Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect correlation (0.8152) between measurements of CO via ultrasound vs. invasive modalities. The ICC between POCUS and the invasive measurement via PCA was 0.84 and via PA catheter 0.74, showing substantial agreement between the ultrasound and both invasive modalities.

Conclusions: Common carotid artery POCUS offers a non-invasive method of measuring the CO in the critically ill population.

Background: La misurazione della gittata cardiaca (CO) in Unità di Terapia Intensiva (ICU) richiede dispositivi invasivi come il cateterismo dell’arteria polmonare (PA) o l’analisi dell’onda dell’impulso arterioso (PCA). Questo studio si propone di valutare l’accuratezza e la fattibilità dell’ecografia (POCUS) della carotide comune per stimare la CO in modo non invasivo e confrontarla con le modalità esistenti di misurazione della CO effettuate in maniera invasiva.

Metodi: I pazienti ricoverati in terapia intensiva chirurgica e cardiotoracica in un centro accademico, affiliato con l’università, nel corso di un periodo di quattro mesi, sottoposti a dispositivi di monitoraggio emodinamico invasivo sono stati inclusi in questo studio. E’ stata eseguita l’ecografia dell’arteria carotide comune per misurare la CO ed i risultati sono stati confrontati con una tecnica invasiva.

Risultati: Medici di terapia intensiva e borsisti, utilizzando l’ecografia della carotide comune, hanno ottenuto le misurazioni della CO. Immagini del flusso Doppler e di volume sono state ottenute a livello della ghiandola tiroidea. Contemporaneamente è è stata registrata la CO mediante dispositivi invasivi. Il gruppo era costituito da 36 pazienti; Il 52 % erano femmine. L’età media era di 59 ± 13 anni, e il 66 % sono stati monitorati tramite dispositivo PCA e il 33 % tramite catetere PA. L’analisi del coefficiente di correlazione (ICC) ha dimostrato la correlazione quasi perfetta (0,8152) tra le misurazioni della CO con gli ultrasuoni e quelle con modalità invasive. Il ICC tra POCUS e la misurazione invasiva tramite PCA era 0,84 e catetere della PA era 0,74 mostrando sostanziale accordo tra l’ecografia e entrambe le modalità invasive.

Conclusioni: La POCUS dell’arteria carotide comune offre un metodo non invasivo per misurare la CO nel paziente critico.

Keywords: Cardiac output; Carotid doppler; Point of care ultrasound; Pulmonary artery catheter; Pulse contour analysis; Ultrasound.

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Figures

Fig. 1
Fig. 1
a Position of the linear ultrasound transducer at the level of the thyroid gland in a cross-sectional orientation to measure the common carotid artery diameter (displayed in the small box). b Position of the linear ultrasound transducer at the level of the thyroid gland in a longitudinal orientation with the application of the color flow and Doppler to measure the flow volume (displayed in the small box)
Fig. 2
Fig. 2
a Scatter plot diagram showing the overall correlation between cardiac output measurements using invasive modalities versus ultrasound. b The Bland–Altman plot indicating that for the most part, the overall cardiac output measurements tend to agree with a mean difference close to zero and there is no statistical difference between the cardiac output measurement by invasive modality and ultrasound. P = 0.262. CO cardiac output in L/min
Fig. 3
Fig. 3
a Scatter plot diagram showing the correlation between cardiac output measurements using the pulse contour analysis vs. ultrasound. CO cardiac output. PCA pulse contour analysis. b Scatter plot diagram showing the correlation between cardiac output measurements using the pulmonary artery catheter vs. ultrasound. CO cardiac output. PAC pulmonary artery catheter
See this image and copyright information in PMC

References

    1. Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K (2013) Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev 2: CD003408. doi:10.1002/14651858.CD003408.pub3 - PMC - PubMed
    1. Gershengorn HB, Wunsch H. Understanding changes in established practice: pulmonary artery catheter use in critically III patients. Crit Care Med. 2013;41(12):2667–2676. doi: 10.1097/CCM.0b013e318298a41e. - DOI - PMC - PubMed
    1. Killu K, Oropello J, Manasia A. Effect of lower limb compression devices on thermodilution cardiac output measurement. Crit Care Med. 2007;35(5):1307–1311. doi: 10.1097/01.CCM.0000262387.37554.2E. - DOI - PubMed
    1. Le Langlois SP. Focused ultrasound training for clinicians. Crit Care Med. 2007;35(5):S138–S143. doi: 10.1097/01.CCM.0000260625.63077.05. - DOI - PubMed
    1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757. doi: 10.1056/NEJMra0909487. - DOI - PubMed

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