Noninvasive versus invasive assessment of cardiac output after cardiac surgery: clinical validation.

The accuracy of noninvasive cardiac output (CO) measurement techniques, such as electrical bioimpedance (BIO), suprasternal continuous-wave Doppler (CWD), pulsed-wave Doppler (PWD), and transesophageal continuous-wave Doppler (TED) ultrasound has been variably judged in recent years. In addition, clinical comparisons are hampered by the fact that there is no generally accepted gold standard in CO measurement. After coronary artery bypass surgery in 25 patients, CO was simultaneously determined by invasive standard techniques (thermodilution [TD] and Fick methods) plus BIO, CWD, PWD, and TED. There was an excellent agreement found between TD and the Fick method (COF = 0.13 + 1.01.COTD; r = 0.96; n = 99). Thermodilution was thus chosen to be the reference method. Bioimpedance underestimated COTD (COBIO = 0.47 + 0.60.COTD; r = 0.78; n = 111). Allowing physiological ejection times only led to an improved agreement between BIO and TD (COBIO = 0.05 + 0.69.COTD; r = 0.82; n = 79), but BIO still significantly underestimated COTD (P less than 0.0005). Using physiologic ejection times during COCWD determination reduced the scatter of data as compared with TD; however, CWD still considerably overestimated COTD, when COCWD computation was based on the echocardiographic aortic diameter (ECHO) (COCWD ECHO = 0.79 + 1.40.COTD; r = 0.84; n = 52). With the surgical aortic diameter (SURG), the agreement improved (COCWD SURG = 0.75 + 1.16.COTD; r = 0.89; n = 44), but overestimation of COTD remained significant (P less than 0.05). Irrespective of the aortic diameter, COPWD values showed a considerable scatter of data compared with COTD (COPWD ECHO = 1.26 + 0.60.COTD; r = 0.62; n = 64 and COPWD SURG = 1.42 + 0.41.COTD; r = 0.47; n = 61). Correlation of absolute COTED values to thermodilution depended on the method used for calibration. All investigated noninvasive CO measurement techniques unreliably measured relative CO changes. Despite its invasiveness, TD remains the method of choice for accurate CO determination in adult patients following cardiac surgery.