Basic critical care echocardiography training of intensivists allows reproducible and reliable measurements of cardiac output

Christian Villavicencio; Julen Leache; Judith Marin; Iban Oliva; Alejandro Rodriguez; María Bodí; Nilam J Soni

doi:10.1186/s13089-019-0120-0

Basic critical care echocardiography training of intensivists allows reproducible and reliable measurements of cardiac output

Ultrasound J. 2019 Apr 16;11(1):5. doi: 10.1186/s13089-019-0120-0.

Authors

Christian Villavicencio¹, Julen Leache², Judith Marin³, Iban Oliva², Alejandro Rodriguez², María Bodí², Nilam J Soni^{4

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Affiliations

¹ Critical Care Department, Joan XXIII-University Hospital, Mallafre Guasch 4, 43007, Tarragona, Spain. christiananda@hotmail.com.
² Critical Care Department, Joan XXIII-University Hospital, Mallafre Guasch 4, 43007, Tarragona, Spain.
³ Critical Care Department, Hospital del Mar-Research Group in Critical Illness (GREPAC), Institut Hospital del Mar d'investigacions Mèdiques (IMIM), Barcelona, Spain.
⁴ Division of Pulmonary & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
⁵ Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
⁶ Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA.

Abstract

Background: Although pulmonary artery catheters (PACs) have been the reference standard for calculating cardiac output, echocardiographic estimation of cardiac output (CO) by cardiologists has shown high accuracy compared to PAC measurements. A few studies have assessed the accuracy of echocardiographic estimation of CO in critically ill patients by intensivists with basic training. The aim of this study was to evaluate the accuracy of CO measurements by intensivists with basic training using pulsed-wave Doppler ultrasound vs. PACs in critically ill patients.

Methods: Critically ill patients who required hemodynamic monitoring with a PAC were eligible for the study. Three different intensivists with basic critical care echocardiography training obtained three measurements of CO on each patient. The maximum of three separate left-ventricular outflow tract diameter measurements and the mean of three LVOT velocity time integral measurements were used. The inter-observer reliability and correlation of CO measured by PACs vs. critical care echocardiography were assessed.

Results: A total of 20 patients were included. Data were analyzed comparing the measurements of CO by PAC vs. echocardiography. The inter-observer reliability for measuring CO by echocardiography was good based on a coefficient of intraclass correlation of 0.6 (95% CI 0.48-0.86, p < 0.001). Bias and limits of agreement between the two techniques were acceptable (0.64 ± 1.18 L/min, 95% limits of agreement of - 1.73 to 3.01 L/min). In patients with CO < 6.5 L/min, the agreement between CO measured by PAC vs. echocardiography improved (0.13 ± 0.89 L/min; 95% limits of agreement of - 1.64 to 2.22 L/min). The mean percentage of error between the two methods was 17%.

Conclusions: Critical care echocardiography performed at the bedside by intensivists with basic critical care echocardiography training is an accurate and reproducible technique to measure cardiac output in critically ill patients.

Keywords: Cardiac output; Critical care echocardiography; Pulmonary artery catheter; Pulsed-wave Doppler.