Key result
Non-Invasive Cardiac System (NICaS) demonstrated a strong positive correlation with continuous thermodilution for measuring cardiac index (r = 0.765), but the parameters are not interchangeable due to wide limits of agreement and a 64% percentage error.
Why the study?
Cardiac output assessment is central to advanced haemodynamic management in critically ill patients, prompting validation of NICaS-derived cardiac index and output against thermodilution in post-operative cardiac surgical patients.
Does continuous cardiac output monitoring derived from regional impedance cardiography accurately correlate with continuous thermodilution in post-operative CABG patients?
Observational (n=23)
No
Does continuous cardiac output monitoring derived from regional impedance cardiography accurately correlate with continuous thermodilution in post-operative CABG patients?
While regional impedance cardiography demonstrates good trending ability for cardiac output, its high percentage error indicates it is not interchangeable with continuous thermodilution in post-operative cardiac surgical patients.
Answers are grounded in this paper and cite their sources.
NICaS shows good trending ability but lacks interchangeability with thermodilution; leaves open its role as a noninvasive alternative pending further validation.
Background: Cardiac output (CO) assessment is a corner stone in advanced haemodynamic management, especially in critical ill patients. The present study was conducted to validate cardiac index and cardiac output by NICaS™ with the thermodilution technique using pulmonary artery catheter in post-operative cardiac surgical patients. Materials and Methods: This was a prospective observational clinical study conducted at a tertiary care hospital. 23 adult patients in the age range of 18-65 years who had undergone for elective coronary artery bypass grafting were included in the study. Results: Spearman's correlation coefficient of cardiac index between continuous Thermodilution (cTD) and Non-Invasive Cardiac System (NICaS™) showed a good correlation (r = 0.765, 95% confidence interval 0.70 to 0.82, P < 0.0001). There was a good correlation between cTD and NICaS™ for cardiac output (r = 0.759, 95% confidence interval 0.69 to 0.81, P < 0.0001), Bland-Altman plot for cardiac index between cTD and NICaS™ showed a mean bias of -0.66 ± 0.6919 with limits of agreement being -2.02 to 0.6936. Bland-Altman plot for cardiac output between cTD and NICaS™ showed a mean bias of -1.0386 ± 1.17 with limits of agreement being -3.34 to + 1.26. Percentage error for cardiac index and cardiac output were 64.78% and 64% respectively. Polar plot analysis showed an angular bias of 6.32° with radial limits of agreement being -8.114° to 20.75° for cardiac index and angular bias of 5.6682° with radial limits of agreement being -9.1422° to 20.4784° for cardiac output. Conclusion: NICaS™ demonstrated a good trending ability for both CI and CO. However, NICaS™ derived parameters are not interchangeable with the values derived from continuous thermodilution technique.
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Singh et al. (2020) conducted an observational in Post-operative cardiac surgery (n=23). Non-Invasive Cardiac System (NICaS) vs. Continuous thermodilution technique (cTD) using pulmonary artery catheter was evaluated on Correlation of cardiac index between continuous thermodilution and NICaS (r = 0.765, 95% CI 0.70 to 0.82, p=<0.0001). Non-Invasive Cardiac System (NICaS) demonstrated a strong positive correlation with continuous thermodilution for measuring cardiac index (r = 0.765), but the parameters are not interchangeable due to wide limits of agreement and a 64% percentage error.
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