Yonsei Med J.  2019 Aug;60(8):735-741. 10.3349/ymj.2019.60.8.735.

Accuracy and Efficacy of Impedance Cardiography as a Non-Invasive Cardiac Function Monitor

• Kim GE
• Kim SY
• Kim SJ
• Yun SY
• Jung HH
• Kang YS
• Koo BN

• KMID: 2452954
• DOI: http://doi.org/10.3349/ymj.2019.60.8.735

Abstract

PURPOSE
The most common method of monitoring cardiac output (CO) is thermodilution using pulmonary artery catheter (PAC), but this method is associated with complications. Impedance cardiography (ICG) is a non-invasive CO monitoring technique. This study compared the accuracy and efficacy of ICG as a non-invasive cardiac function monitoring technique to those of thermodilution and arterial pressure contour.
MATERIALS AND METHODS
Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured by thermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Bland-Altman analysis to assess the degree of agreement.
RESULTS
The difference by thermodilution and ICG was 1.13 L/min/m², and the limits of agreement were −0.93 and 3.20 L/min/m². The difference by thermodilution and arterial pressure contour was 0.62 L/min/m², and the limits of agreement were −1.43 and 2.67 L/min/m². The difference by arterial pressure contour and ICG was 0.50 L/min/m², and the limits of agreement were −1.32 and 2.32 L/min/m². All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed between CI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilution and arterial waveform analysis at preanhepatic phase. Others showed moderate agreement.
CONCLUSION
Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation with thermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely require further studies in other settings.

Keyword

Cardiac output; thermodilution; impedance cardiography; liver transplantation

MeSH Terms

Arterial Pressure
Cardiac Output
Cardiography, Impedance*
Catheters
Electric Impedance*
Humans
Liver Transplantation
Methods
Pulmonary Artery
Thermodilution

Figure

• 

  Fig. 1 Bland-Altman plot between diagnostic modalities measuring cardiac output in liver transplantation. (A) Bland-Altman plot between thermodilution with pulmonary artery catheter (PAC) and impedance cardiography (ICG). (B) Bland-Altman plot between thermodilution with PAC and arterial waveform analysis (FloTrac). (C) Bland-Altman plot between FloTrac and ICG.

• 

  Fig. 2 Bland-Altman plot between diagnostic modalities measuring cardiac output in preanhepatic phase. (A) Bland-Altman plot between thermodilution with pulmonary artery catheter (PAC) and impedance cardiography (ICG). (B) Bland-Altman plot between thermodilution with PAC and arterial waveform analysis (FloTrac). (C) Bland-Altman plot between FloTrac and ICG.

• 

  Fig. 3 Bland-Altman plot between diagnostic modalities measuring cardiac output in anhepatic phase. (A) Bland-Altman plot between thermodilution with pulmonary artery catheter (PAC) and impedance cardiography (ICG). (B) Bland-Altman plot between thermodilution with PAC and arterial waveform analysis (FloTrac). (C) Bland-Altman plot between FloTrac and ICG.

• 

  Fig. 4 Bland-Altman plot between diagnostic modalities measuring cardiac output in neohepatic phase. (A) Bland-Altman plot between thermodilution with pulmonary artery catheter (PAC) and impedance cardiography (ICG). (B) Bland-Altman plot between thermodilution with PAC and arterial waveform analysis (FloTrac). (C) Bland-Altman plot between FloTrac and ICG.

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