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Cardiac index measurements by transcutaneous Doppler ultrasound and transthoracic echocardiography in adult and pediatric emergency patients

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Abstract

Introduction

Non-invasive hemodynamic monitoring may facilitate resuscitation in critically ill patients. Validation studies examining a transcutaneous Doppler ultrasound technology, USCOM-1A, using pulmonary artery catheter as the reference standard showed varying results. In this study, we compared non-invasive cardiac index (CI) measurements by USCOM-1A with transthoracic echocardiography (TTE).

Methods

This study was a prospective, observational cohort study at a university tertiary-care emergency department, enrolling a convenience sample of adult and pediatric patients. Paired measures of CI, stroke volume index (SVI), aortic outflow tract diameter (OTD), velocity time integral (VTI) were obtained using USCOM-1A and TTE. Pearson’s correlation and Bland–Altman analyses were performed.

Results

One-hundred and sixteen subjects were enrolled, with obtainable USCOM-1A CI measurements for 99 subjects (55 adults age 50 ± 20 years and 44 children age 11 ± 4 years) in the final analysis. Cardiac, gastrointestinal and infectious illnesses were the most common presenting diagnostic categories. The reference standard TTE measurements of CI, SVI, OTD, and VTI in all subjects were 3.08 ± 1.18 L/min/m2, 37.10 ± 10.91 mL/m2, 1.92 ± 0.36 cm, and 20.36 ± 4.53 cm, respectively. Intra-operator reliability of USCOM-1A CI measurements showed a correlation coefficient of r = 0.79, with 11 ± 22% difference between repeated measures. The bias and limits of agreement of USCOM-1A compared to TTE CI were 0.58 (−1.48 to 2.63) L/min/m2. The percent difference in CI measurements with USCOM-1A was 31 ± 28% relative to TTE measurements.

Conclusions

The USCOM-1A hemodynamic monitoring technology showed poor correlation and agreement to standard transthoracic echocardiography measures of cardiac function. The utility of USCOM-1A in the management of critically ill patients remains to be determined.

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Acknowledgments

This study was partially funded by USCOM Pty Ltd, Australia. USCOM Pty Ltd did not participate in the study design or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda University, 11234 Anderson Street, Room A108, Loma Linda, CA, 92354, USA

    H. Bryant Nguyen MD, MS, William A. Wittlake MD & Stephen W. Corbett MD, PhD

  2. Division of Pediatric Emergency Medicine, Loma Linda University, Loma Linda, CA, USA

    Gail Stewart DO & Tommy Kim MD

  3. Division of Cardiology, Loma Linda University, Loma Linda, CA, USA

    Ramesh Bansal MD

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA, USA

    H. Bryant Nguyen MD, MS, Daryl P. Banta MD & James Anholm MD

Authors
  1. H. Bryant Nguyen MD, MS
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  2. Daryl P. Banta MD
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  3. Gail Stewart DO
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  4. Tommy Kim MD
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  5. Ramesh Bansal MD
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  6. James Anholm MD
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  7. William A. Wittlake MD
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  8. Stephen W. Corbett MD, PhD
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Corresponding author

Correspondence to H. Bryant Nguyen MD, MS.

Additional information

Nguyen HB, Banta DP, Stewart G, Kim T, Bansal R, Anholm J, Wittlake WA, Corbett SW. Cardiac index measurements by transcutaneous Doppler ultrasound and transthoracic echocardiography in adult and pediatric emergency patients.

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Nguyen, H.B., Banta, D.P., Stewart, G. et al. Cardiac index measurements by transcutaneous Doppler ultrasound and transthoracic echocardiography in adult and pediatric emergency patients. J Clin Monit Comput 24, 237–247 (2010). https://doi.org/10.1007/s10877-010-9240-6

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  • DOI: https://doi.org/10.1007/s10877-010-9240-6

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