Assessment of Cardiac Output With EtCO2 (COCO2)

Assessment of Cardiac Output With End-tidal Carbon Monoxide

Hemodynamic monitoring, especially cardiac output assessment, is a key feature for the management of critically ill patients. Although the use of invasive methods, such as thermodilution with a pulmonary artery catheter, remains the GOLD standard for the evaluation of the cardiac output, several non-invasive techniques are currently used in practice. An acceptable estimation of the cardiac output can be made by standard transthoracic echocardiography. Cardiac output can be calculated from subaortic velocity time integral (VTI). However, this technique requires a trained operator and depends on the echogenicity of the patient. The best method for assessing cardiac output depends on the patient's needs, the clinical scenario and the physician's experience with the monitoring device itself. No simple and rapid tool currently exist for assessing cardiac output in critically ill patients.

The measurement of end-tidal carbon dioxide (EtCO2) used in routine in critically ill patients requiring mechanical ventilation could be an interesting alternative. Indeed, the amount of carbon dioxide (CO2) exhaled depends on the production of CO2 by the body, the pulmonary blood flow (corresponding to cardiac output) and its elimination by alveolar ventilation. In controlled ventilation, ie for constant alveolar ventilation, EtCO2 should therefore depend only on cardiac output. It has been shown in a porcine model that EtCO2 and cardiac output are strongly related under stable respiratory and metabolic conditions. In humans, only the variation of EtCO2 after volume expansion has been studied and EtCO2 seems to reflect changes in cardiac output. Nevertheless, the usefulness of EtCO2 in assessing cardiac output has never been evaluated.

The objective of this study is therefore to determine the relationship between EtCO2 and cardiac output evaluated by the measurement of subaortic VTI in critically ill patients.

Study Overview

• Status: Unknown
• Conditions: Cardiac Output
• Intervention / Treatment: Diagnostic test: End tidal carbon monoxide

• Study Type: Observational
• Enrollment (Anticipated): 75

Contacts and Locations

Study Locations

• France
  • Besançon, France, 25000
    • Recruiting
    • Intensive care unit, University hospital of Besançon
    • Contact: Thibaud Soumagne, MD, PhD; Phone Number: +33682535947; Email: thibaud_soumagne@live.fr
    • Contact: Gaël Piton, MD, PhD; Phone Number: +33381668059; Email: gpiton@chu-besancon.fr
    • Sub-Investigator: Gaël Piton, MD, PhD
    • Principal Investigator: Thibaud Soumagne, MD, PhD
    • Sub-Investigator: Hadrien Winiszewski, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients > 18 years intubated and ventilated in the control assisted mode with no inspiratory effort referred to the intensive unit.

Description

Inclusion Criteria:

• patients intubated and ventilated in the control assisted mode with no inspiratory effort
• requiring vasopressors

Exclusion Criteria:

• less than 18 years
• refuse to participate
• situation in which health condition, medication or procedure could significantly interfere with the interpretation of EtCO2 or cardiac output (extracorporeal life support, pneumothorax with persistant air leak)

(be increased without correlation to an infectious process (poly-traumatised patients,

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between cardiac output (VTI) and EtCO2	ITV ≈ (FR x EtCO2)/PaCO2	between 0 to 3 day after ICU admission

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Increase the sensitivity for detection of low cardiac output by using EtCO2	Estimate (development population) and validate (validation population) cut-off to detect low cardiac output by using EtCO2	between 0 to 3 day after ICU admission
Correlation between cardiac output (VTI) and portal veinous velocity		between 0 to 3 day after ICU admission
Comparison between cardiac output (VTI) and femoral veinous velocity		between 0 to 3 day after ICU admission

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Besancon

Publications and helpful links

General Publications

• Mercado P, Maizel J, Beyls C, Titeca-Beauport D, Joris M, Kontar L, Riviere A, Bonef O, Soupison T, Tribouilloy C, de Cagny B, Slama M. Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Crit Care. 2017 Jun 9;21(1):136. doi: 10.1186/s13054-017-1737-7.
• Long B, Koyfman A, Vivirito MA. Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations. J Emerg Med. 2017 Dec;53(6):829-842. doi: 10.1016/j.jemermed.2017.08.026. Epub 2017 Oct 7.
• Weil MH, Bisera J, Trevino RP, Rackow EC. Cardiac output and end-tidal carbon dioxide. Crit Care Med. 1985 Nov;13(11):907-9. doi: 10.1097/00003246-198511000-00011.
• Monnet X, Bataille A, Magalhaes E, Barrois J, Le Corre M, Gosset C, Guerin L, Richard C, Teboul JL. End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test. Intensive Care Med. 2013 Jan;39(1):93-100. doi: 10.1007/s00134-012-2693-y. Epub 2012 Sep 19.

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2020
• Primary Completion (ANTICIPATED): December 31, 2020
• Study Completion (ANTICIPATED): December 31, 2020

Study Registration Dates

• First Submitted: April 9, 2018
• First Submitted That Met QC Criteria: May 2, 2018
• First Posted (ACTUAL): May 14, 2018

Study Record Updates

• Last Update Posted (ACTUAL): January 31, 2020
• Last Update Submitted That Met QC Criteria: January 30, 2020
• Last Verified: December 1, 2019

More Information

Terms related to this study

• Keywords: echocardiography; intensive care; cardiac output; end tidal carbon monoxide
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Antimetabolites; Gasotransmitters; Carbon Monoxide
• Other Study ID Numbers: P/2018/367

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No