Key result
Esophageal Doppler fails to reliably match thermodilution cardiac output during off-pump CABG.
Why the study?
Esophageal doppler is described as a non-invasive alternative to thermodilution for cardiac output estimation, but its accuracy compared to thermodilution in off-pump coronary artery bypass surgery patients is uncertain.
Observational (n=16)
No
Effect estimate: Bias (EDCO-TDCO) ranged from -0.6 to -0.9 L/min with limits of agreement up to -4.5 to 2.7 L/min
Supports caution against esophageal Doppler replacement of thermodilution in off-pump CABG; leaves open validation in other perioperative contexts.
Background: Esophageal doppler is discribed as a non-invasive alternative to cardiac output (CO) estimation by thermodilution, the current bedside "gold standard".This study was designed to evaluate the accuracy of CO estimations performed by esophageal doppler (EDCO), compared to those obtained using a continuous CO pulmonary flotation catheter (TDCO).Methods: In 16 patients undergoing off-pump coronary artery bypass surgery, CO was measured simultaneously by the esophageal doppler and the thermodilution method, after induction (A), after sternotomy (B), after coronary revascularization (C), and after sternal closure (D).Agreement between the TDCO and EDCO estimations was assessed by analyzing their mean differences and the distribution of these differences.Relative CO changes (percentages of the previous value) was analyzed by the same method.Results: Both absolute CO values and relative CO changes by esophageal doppler showed a considerable scatter compared to those obtained using the thermodilution method.The bias (EDCO-TDCO) between the two mehtods was -0.8 ± 2.7 L/min for A, -0.9 ± 2.5 L/min for B, -0.9 ± 3.6 L/min for C, and -0.6 ± 2.7 (mean ± 2 SD) L/min for D. On analyzing changes in CO, no significant method bias was found but 2 SD of the bias were ± 74% for A to B, ± 100% for B to C, and ± 83% for C to D. Conclusions:These results suggest that CO estimations by esophageal doppler cannot replace estimations by the thermodilution method in patients undergoing off-pump coronary artery bypass graft surgery.(Korean J Anesthesiol 2003; 45: 456∼461)
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Shim et al. (2003) conducted an observational in Patients undergoing off-pump coronary artery bypass surgery (n=16). Esophageal doppler cardiac output monitoring (EDCO) vs. Continuous thermodilution cardiac output monitoring (TDCO) was evaluated on Agreement between TDCO and EDCO absolute cardiac output values assessed by mean differences (bias) and limits of agreement (Bias (EDCO-TDCO) ranged from -0.6 to -0.9 L/min with limits of agreement up to -4.5 to 2.7 L/min). Cardiac output estimations by esophageal doppler showed considerable scatter and wide limits of agreement compared to the thermodilution method, suggesting it cannot replace thermodilution in patients undergoing off-pump coronary artery bypass surgery.
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