Acute Crit Care.  2024 Feb;39(1):162-168. 10.4266/acc.2023.01095.

The correlation between carotid artery Doppler and stroke volume during central blood volume loss and resuscitation

• Kerrebijn I
• Atwi S
• Elfarnawany M
• Eibl AM
• Eibl JK
• Taylor JL
• Kim CH
• Johnson BD
• Kenny J

• KMID: 2555235
• DOI: http://doi.org/10.4266/acc.2023.01095

Abstract

Background
Using peripheral arteries to infer central hemodynamics is common among hemodynamic monitors. Doppler ultrasound of the common carotid artery has been used in this manner with conflicting results. We investigated the relationship between changing common carotid artery Doppler measures and stroke volume (SV), hypothesizing that more consecutively-averaged cardiac cycles would improve SV-carotid Doppler correlation. Methods: Twenty-seven healthy volunteers were recruited and studied in a physiology laboratory. Carotid artery Doppler pulse was measured with a wearable, wireless ultrasound during central hypovolemia and resuscitation induced by a stepped lower body negative pressure protocol. The change in maximum velocity time integral (VTI) and corrected flow time of the carotid artery (ccFT) were compared with changing SV using repeated measures correlation. Results: In total, 73,431 cardiac cycles were compared across 27 subjects. There was a strong linear correlation between changing SV and carotid Doppler measures during simulated hemorrhage (repeated-measures linear correlation [Rrm ]=0.91 for VTI; 0.88 for ccFT). This relationship improved with larger numbers of consecutively-averaged cardiac cycles. For ccFT, beyond four consecutively-averaged cardiac cycles the correlation coefficient remained strong (i.e., Rrm of at least 0.80). For VTI, the correlation coefficient with SV was strong for any number of averaged cardiac cycles. For both ccFT and VTI, Rrm remained stable around 25 consecutively-averaged cardiac cycles. Conclusions: There was a strong linear correlation between changing SV and carotid Doppler measures during central blood volume loss. The strength of this relationship was dependent upon the number of consecutively-averaged cardiac cycles.

Keyword

carotid artery; corrected flow time; doppler ultrasound; functional hemodynamic monitoring; wearable technology, velocity time integral

Figure

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  Figure 1. Wearable Doppler ultrasound and representative results. (A) The wearable Doppler ultrasound worn over the right common carotid artery of a healthy subject. (B) Representative Doppler spectrograms from left to right showing increasingly severe lower body negative pressure (LBNP). The green bars at the base are the common carotid corrected flow time (ccFT) per cardiac cycle and time on the X-axis. (C) Representative results from a single LBNP protocol showing two carotid ultrasound measures: ccFT and velocity time integral (VTI) compared to stroke volume (SV) and mean arterial pressure (MAP). Release was when the LBNP chamber returned to atmospheric pressure.

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  Figure 2. The relationship between change in common carotid artery corrected flow time (ccFT) and velocity time integral (VTI) with stroke volume (SV) in a model of central blood volume loss. (A) The relationship between SV % change from baseline and ccFT % change from baseline using whole stage averages. Across decreasing pressure stages, the repeated-measures linear correlation (Rrm) is 0.88 and the slope is 0.33. (B) The relationship between SV % change from baseline and ccFT % change from baseline using 10-beat averages. Across decreasing pressure stages, the Rrm is 0.83 and the slope is 0.30. (C) The effect of the number of consecutively-averaged cardiac cycles on repeated-measures correlation coefficient between % change SV and % change ccFT. (D) The relationship between SV % change from baseline and VTI % change from baseline using whole stage averages. Across decreasing pressure stages, the Rrm is 0.91 and the slope is 1.18. (E) The relationship between SV % change from baseline and VTI % change from baseline using 10-beat averages. Across decreasing pressure stages, the Rrm is 0.86 and the slope is 1.16. (F) The effect of the number of consecutively-averaged cardiac cycles on repeated-measures correlation coefficient between % change SV and % change VTI.

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