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Transoesophageal echocardiography accurately detects cardiac output variation: a prospective comparison with thermodilution in cardiac surgery

Parra, V.*; Fita, G.; Rovira, I.; Matute, P.; Gomar, C.; Paré, C.

European Journal of Anaesthesiology (EJA): February 2008 - Volume 25 - Issue 2 - p 135–143
doi: 10.1017/S0265021507001354
Original Article

Background and objective: Intraoperative Doppler ultrasound can be used to measure cardiac output by transoesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surgery. We also assessed the agreement between the techniques.

Methods: Fifty cardiac surgical patients (38 male, 12 female, mean age of 63.4 ± 14.3 yr) were prospectively included after approval by the Ethics Committee of the Institution. Cardiac output was assessed by thermodilution, with 10 mL saline at 12°C, and simultaneously and blindly by echo-Doppler in deep transgastric view with pulsed wave Doppler at the level of the left ventricular outflow tract. Matched thermodilution cardiac output and echo-Doppler cardiac output measurements were taken three times at the end of expiration, both pre- and post-cardiopulmonary bypass.

Results: Echo-Doppler measurements were obtained in 44 patients (88%). In three patients, Doppler recordings could not be obtained adequately, and three developed left ventricular outflow tract obstruction after bypass. Bland-Altman analysis revealed a bias of 0.015 L min−1, with narrow limits of agreement (−1.21 to 1.22 L min−1) and 29.1% error. Echo-Doppler was accurate (92% sensitivity and 71% specificity, P = 0.008 by receiver operating characteristic curves) for detecting more than 10% of change in thermodilution cardiac output. There were no complications related to the study.

Conclusions: The agreement between cardiac output by echo-Doppler and by thermodilution is clinically acceptable and transoesophageal echocardiography is a reliable tool to assess significant cardiac output changes in a population of selected patients.

*Universidad de Chile, Hospital Clínico y Facultad de Medicina, Anestesiología, Santiago, Chile

Universidad de Barcelona, Hospital Clínic, Anestesiología, Spain

Universidad de Barcelona, Hospital Clínic, Unidad de Ecocardiografía, Cardiología, Spain

Correspondence to: Victor Parra, Instituto de Ciencias Biomédicas, Facultad de Medicina Universidad de Chile, Casilla 16038, Avenida Salvador 486 (Providencia), Santiago 9, Chile. E-mail:; Tel: +56 2 2741560; Fax: +56 2 2741628

Accepted for publication 20 June 2007

First published online 2 August 2007

© 2008 European Society of Anaesthesiology