Accuracy and Efficacy of Impedance Cardiography as a Non-Invasive Cardiac Function Monitor
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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 ofthermodilution and arterial pressure contour. Materials and Methods: Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured bythermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performedusing 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 and2.67 L/min/m2. The difference by arterial pressure contour and ICG was 0.50 L/min/m2, and the limits of agreement were -1.32and 2.32 L/min/m2. All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed betweenCI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilutionand arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. Conclusion: Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation withthermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely requirefurther studies in other settings.
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 ofthermodilution and arterial pressure contour. Materials and Methods: Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured bythermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performedusing 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 and2.67 L/min/m2. The difference by arterial pressure contour and ICG was 0.50 L/min/m2, and the limits of agreement were -1.32and 2.32 L/min/m2. All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed betweenCI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilutionand arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. Conclusion: Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation withthermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely requirefurther studies in other settings.
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