Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization

Objective: To evaluate the accuracy and precision of an advanced thoracic bioimpedance cardiac output monitor by comparing it with conventional thermodilution. Design: Prospective data collected from 47 patients undergoing routine cardiac catheterization. The new bioimpedance system differs from its predecessors in electrode system configuration, advanced signal processing, use of a modified Kubicek equation, and a reliable estimate of left ventricular ejection time from the time derivative bioimpedance signals. Setting: A cardiac catheterization laboratory in a university affiliated teaching hospital. Patients: A series of 47 relatively homogenous patients undergoing routine cardiac catheterization for suspected cardiac disease. Measurements and Main Results: The data from the first 20 patients was used to determine optimal values for coefficients in the bioimpedance cardiac output equations. The coefficients found were used when the system was tested in the subsequent 27 patients. For the last 27 patients, a total of 80 simultaneous pairs of cardiac output measurements were made by conventional thermodilution end by thoracic bioimpedance. The mean difference between the two methods was -0.31 L/min and the standard deviation of the differences was (0.76 L/min), The correlation coefficient was r(2) = .72 (p < .001). Conclusions: The correlation between conventional thermodilution and thoracic bioimpedance cardiac output estimates was good and the standard deviation of the differences was lower than that reported for commercially available devices. The system can be used in the cardiac catheterization lab for reliable and continuous noninvasive measurement of cardiac output.