Key result
The Ultrasonic Cardiac Output Monitor (USCOM) underestimated cardiac index compared to echocardiography (mean percent difference -9.6%) and demonstrated poor agreement for stroke volume.
Why the study?
Data on the accuracy of the Ultrasonic Cardiac Output Monitor in young, critically ill, mechanically ventilated, hemodynamically supported pediatric patients were scarce.
Does the Ultrasonic Cardiac Output Monitor (USCOM) accurately agree with echocardiography for measuring cardiac output in mechanically ventilated pediatric patients immediately post-congenital heart surgery?
Observational (n=61)
No
Does the Ultrasonic Cardiac Output Monitor (USCOM) accurately agree with echocardiography for measuring cardiac output in mechanically ventilated pediatric patients immediately post-congenital heart surgery?
Effect estimate: Mean CI percent difference -9.6%
USCOM demonstrates poor agreement with echocardiography and underestimates cardiac index in mechanically ventilated pediatric patients immediately following congenital heart surgery, suggesting it should be used with caution.
USCOM warrants caution in ventilated pediatric post-cardiac surgery monitoring; leaves open need for prospective validation versus echocardiography.
RATIONAL AND OBJECTIVES: Non-invasive cardiac output (CO) measurements are essential during the immediate post-operative course of young, congenital heart repaired patients. The use of the Ultrasonic Cardiac Output Monitor (USCOM) in pediatric intensive care units (PICU) is increasing. The literature on accuracy of USCOM in young, critically ill, mechanically ventilated, hemodynamically supported patients is scarce. We aimed to assess agreement between the USCOM device and echocardiography for measurements of CO in this population. MATERIALS (PATIENTS) AND METHODS: A prospective observational study in a pediatric cardiac intensive care unit (PCICU). Paired CO measurements were taken in young, mechanically ventilated, immediate post-operative patients with exclusion of unrepaired or residual intra-cardiac shunt, using USCOM and echocardiography, by two separate senior performers. Agreement between echocardiography and USCOM was assessed by percentage error and Bland-Altman analysis. RESULTS: One hundred and thirteen comparison scans were performed on 61 patients: mean age 94 ± 111 d, weight 4.7 ± 2.1 kg, vaso-inotropic score 15.3 ± 11, and STAT score 3-4 (46%). Mean USCOM cardiac index (CI) percent difference was -9.6% (45.6) and velocity-time-integral (VTI) 8.9% (34.7). Bland-Altman analyzes demonstrated poor agreement comparing USCOM to echocardiography with regard to CI, stroke volume (SV), VTI and aortic diameter (AO) measurements. CONCLUSION: Our study shows that USCOM underestimates CI in comparison with echocardiography; therefore USCOM should be used with great caution as an absolute estimate or surrogate of CI in neonates and infants in the immediate post-operative, congenital heart surgery period.
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Shostak et al. (2022) conducted an observational in Congenital heart disease (post-operative) (n=61). Ultrasonic Cardiac Output Monitor (USCOM) vs. Echocardiography was evaluated on Agreement between echocardiography and USCOM for measurements of cardiac output (Mean CI percent difference -9.6%). The Ultrasonic Cardiac Output Monitor (USCOM) underestimated cardiac index compared to echocardiography (mean percent difference -9.6%) and demonstrated poor agreement for stroke volume.
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