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BJA Advance Access published online on September 9, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei224
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oxfordjournals.org
Accepted July 1, 2005

Clinical Investigation

Comparison of electrical velocimetry and transoesophageal Doppler echocardiography for measuring stroke volume and cardiac output{dagger}

C. Schmidt 1*, G. Theilmeier 1, H. Van Aken 1, P. Korsmeier 1, S. P. Wirtz 1, E. Berendes 1, A. Hoffmeier 2, and A. Meissner 1

1 Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Münster Hospital, Albert-Schweitzer-Straße 33, D-48149, Münster, Germany
2 Department of Thoracic and Cardiovascular Surgery, University of Münster Hospital, Albert-Schweitzer-Straße 33, D-48149, Münster, Germany

* To whom correspondence should be addressed.
C. Schmidt, E-mail: schmch{at}uni-muenster.de


  Abstract

Background. Impedance cardiography (ICG) has been used extensively to estimate stroke volume (SV) and cardiac output (CO) from changes of thoracic electrical bioimpedance (TEB). However, studies comparing ICG with reference methods have questioned the reliability of this approach. Electrical velocimetry (EV) provides a new algorithm to calculate CO from variations in TEB. As the transoesophageal Doppler echocardiographic quantification of CO (TOE-CO) has emerged as a reliable method, the purpose of this study was to determine the limits of agreement between CO estimations using EV (EV-CO) and TOE-CO.

Methods. Standard ECG electrodes were used for non-invasive EV-CO measurements. These were placed on 37 patients scheduled for coronary artery surgery necessitating transoesophageal echocardiography monitoring. Simultaneous EV-CO and TOE-CO measurements were recorded after induction of anaesthesia. EV-CO was calculated using the Bernstein-Osypka equation. TOE-CO was measured across the aortic valve using continuous-wave Doppler echocardiography and a triangular orifice model.

Results. A significant high correlation was found between the TOE-CO and the EV-CO measurements (r2=0.86). Data were related linearly. The slope of the line (1.10 (SE 0.07)) was not significantly different from unity, and the point at which it intersected the ordinate (-0.46 (0.32) litre min-1) was not significantly different from zero. Bland-Altman analysis revealed a bias of 0.18 litre min-1 with narrow limits of agreement (-0.99 to 1.36 litre min-1).

Conclusions. The agreement between EV-CO and TOE-CO is clinically acceptable, and these two techniques can be used interchangeably.

Keywords: measurement techniques, Doppler echocardiography; measurement techniques, thermodilution; measurement techniques, thoracic impedance cardiography; measurement techniques, transthoracic electrical impedance.
{dagger}Declaration of interest. This study was supported by Osypka Medical GmbH, Berlin, Germany.
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