Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements

Irene W Y Ma, Joshua D Caplin, Aftab Azad, Christina Wilson, Michael A Fifer, Aranya Bagchi, Andrew S Liteplo, Vicki E Noble, Irene W Y Ma, Joshua D Caplin, Aftab Azad, Christina Wilson, Michael A Fifer, Aranya Bagchi, Andrew S Liteplo, Vicki E Noble

Abstract

Background: Non-invasive measures that can accurately estimate cardiac output may help identify volume-responsive patients. This study seeks to compare two non-invasive measures (corrected carotid flow time and carotid blood flow) and their correlations with invasive reference measurements of cardiac output. Consenting adult patients (n = 51) at Massachusetts General Hospital cardiac catheterization laboratory undergoing right heart catheterization between February and April 2016 were included. Carotid ultrasound images were obtained concurrently with cardiac output measurements, obtained by the thermodilution method in the absence of severe tricuspid regurgitation and by the Fick oxygen method otherwise. Corrected carotid flow time was calculated as systole time/√cycle time. Carotid blood flow was calculated as π × (carotid diameter)2/4 × velocity time integral × heart rate. Measurements were obtained using a single carotid waveform and an average of three carotid waveforms for both measures.

Results: Single waveform measurements of corrected flow time did not correlate with cardiac output (ρ = 0.25, 95% CI -0.03 to 0.49, p = 0.08), but an average of three waveforms correlated significantly, although weakly (ρ = 0.29, 95% CI 0.02-0.53, p = 0.046). Carotid blood flow measurements correlated moderately with cardiac output regardless of if single waveform or an average of three waveforms were used: ρ = 0.44, 95% CI 0.18-0.63, p = 0.004, and ρ = 0.41, 95% CI 0.16-0.62, p = 0.004, respectively.

Conclusions: Carotid blood flow may be a better marker of cardiac output and less subject to measurements issues than corrected carotid flow time.

Keywords: Cardiac output; Carotid blood flow; Carotid flow time; Carotid ultrasound.

Figures

Fig. 1
Fig. 1
a Carotid systole time, as measured from the start of the systolic upstroke to the start of the dicrotic notch (left). Carotid cycle time, as measured from start of one systolic upstroke to the next (right). b Velocity time integral tracing of the spectral Doppler signal (left). Carotid diameter (right)
Fig. 2
Fig. 2
Flow chart of number of patients enrolled in the study and included in the analyses

References

    1. Kelm DJ, Perrin JT, Cartin-Ceba R, Gajic O, Schenck L, Kennedy CC. Fluid overload in patients with severe sepsis and septic shock treated with early-goal directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock. 2015;43:68–73. doi: 10.1097/SHK.0000000000000268.
    1. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39:259–265. doi: 10.1097/CCM.0b013e3181feeb15.
    1. Acheampong A, Vincent J-L. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015;19:251. doi: 10.1186/s13054-015-0970-1.
    1. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41:1774–1781. doi: 10.1097/CCM.0b013e31828a25fd.
    1. Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. WIll this hemodynamically unstable patient respond to a bolus of intravenous fluids? JAMA. 2016;316:1298–1309. doi: 10.1001/jama.2016.12310.
    1. Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med. 2012;29:352–360. doi: 10.1007/s00134-002-1615-9.
    1. Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, Bello G, Maviglia R, Antonelli M. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med. 2012;36(9):1476–1483.
    1. Monnet X, Teboul JL. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19:18. doi: 10.1186/s13054-014-0708-5.
    1. Pugsley J, Lerner AB. Cardiac output monitoring: is there a gold standard and how do the newer technologies compare? Semin Cardiothorac Vasc Anesth. 2010;14:274–282. doi: 10.1177/1089253210386386.
    1. Dee Boyd K, Thomas SJ, Gold J, Boyd AD. A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest. 1983;84:245–249. doi: 10.1378/chest.84.3.245.
    1. Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton W, Williams D, Young D, Rowan K. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005;366:472–477. doi: 10.1016/S0140-6736(05)67061-4.
    1. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M. A Randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5–14. doi: 10.1056/NEJMoa021108.
    1. Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T, Lefort Y, Fartoukh M, Baud F. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2003;290:2713–2720. doi: 10.1001/jama.290.20.2713.
    1. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM, Sopko G, Califf RM. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA. 2005;294:1664–1670. doi: 10.1001/jama.294.13.1664.
    1. Wheeler A, Bernard G, Thompson B, Schoenfeld D, Wiedemann H, DeBoisblanc B, Connors A, Jr, Hite R, Harabin A. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354:2213–2224. doi: 10.1056/NEJMoa061895.
    1. Benomar B, Ouattara A, Estagnasie P, Brusset A, Squara P. Fluid responsiveness predicted by noninvasive bioreactance-based passive leg raise test. Intensive Care Med. 2010;36:1875–1881. doi: 10.1007/s00134-010-1990-6.
    1. Fagnoul D, Vincent J-L, Backer D. Cardiac output measurements using the bioreactance technique in critically ill patients. Crit Care. 2012;16:460. doi: 10.1186/cc11067.
    1. Raval NY, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput. 2008;22:113–119. doi: 10.1007/s10877-008-9112-5.
    1. Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Noninvasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Med. 2007;33:1191–1194. doi: 10.1007/s00134-007-0640-0.
    1. Kupersztych-Hagege E, Teboul JL, Artigas A, Talbot A, Sabatier C, Richard C, Monnet X. Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. Br J Anaesth. 2013;111:961–966. doi: 10.1093/bja/aet282.
    1. Gunst M, Ghaemmaghami V, Sperry J, Robinson M, O’Keeffe T, Friese R, Frankel H. Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care. J Trauma. 2008;65:509–516. doi: 10.1097/TA.0b013e3181825bc5.
    1. Hossein-Nejad H, Mohammadinejad P, Lessan-Pezeshki M, Davarani SS, Banaie M. Carotid artery corrected flow time measurement via bedside ultrasonography in monitoring volume status. J Crit Care. 2015;30:1199–1203. doi: 10.1016/j.jcrc.2015.08.014.
    1. Stolz LA, Mosier JM, Gross AM, Douglas MJ, Blaivas M, Adhikari S. Can emergency physicians perform common carotid Doppler flow measurements to assess volume responsiveness? W J Emerg Med. 2015;16:255–259. doi: 10.5811/westjem.2015.1.24301.
    1. Adedipe AA, Fly DL, Schwitz SD, Jorgenson DB, Duric H, Sayre MR, Nichol G. Carotid Doppler blood flow measurement during cardiopulmonary resuscitation is feasible: a first in man study. Resuscitation. 2015;96:121–125. doi: 10.1016/j.resuscitation.2015.07.024.
    1. Blehar DJ, Glazier S, Gaspari RJ. Correlation of corrected flow time in the carotid artery with changes in intravascular volume status. J Crit Care. 2014;29:486–488. doi: 10.1016/j.jcrc.2014.03.025.
    1. Shokoohi H, Berry GW, Shahkolahi M, King J, Salimian M, Poshtmashad A, Pourmand A. The diagnostic utility of sonographic carotid flow time in determining volume responsiveness. J Crit Care. 2016;38:231–235. doi: 10.1016/j.jcrc.2016.10.025.
    1. Mackenzie DC, Khan NA, Blehar D, Glazier S, Chang Y, Stowell CP, Noble VE, Liteplo AS. Carotid flow time changes with volume status in acute blood loss. Ann Emerg Med. 2015;66:277–282. doi: 10.1016/j.annemergmed.2015.04.014.
    1. Marik PE, Levitov A, Young A, Andrews L. The use of bioreactance and carotid doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest. 2013;143:364–370. doi: 10.1378/chest.12-1274.
    1. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34:1402–1407. doi: 10.1097/01.CCM.0000215453.11735.06.
    1. American College of Radiology (2016) ACR-AIUM-SRU practice parameter for the performance of an ultrasound examination of the extracranial cerebrovascular system. . Accessed 5 Apr 2017
    1. Tola M, Yurdakul M. Effect of Doppler angle in diagnosis of internal carotid artery stenosis. J Ultrasound Med. 2006;25:1187–1192. doi: 10.7863/jum.2006.25.9.1187.
    1. Ganz W, Donoso R, Marcus HS, Forrester JS, Swan HJ. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol. 1971;27:392–396. doi: 10.1016/0002-9149(71)90436-X.
    1. Callan P, Clark AL. Right heart catheterisation: indications and interpretation. Heart. 2016;102:147–157. doi: 10.1136/heartjnl-2015-307786.
    1. Wilkinson JL. Haemodynamic calculations in the catheter laboratory. Heart. 2001;85:113–120. doi: 10.1136/heart.85.1.113.
    1. Shen D, Lu Z (2006) Computation of correlation coefficient and its confidence interval in SAS. . Accessed 5 Apr 2017
    1. Cohen J. Statistical power analysis for the behavioral sciences. New York: Academic Press; 1988.
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B Methodol. 1995;57:289–300.
    1. Garcia X, Mateu L, Maynar J, Mercadal J, Ochagavía A, Ferrandiz A. Estimating cardiac output. Utility in the clinical practice. Available invasive and non-invasive monitoring. Med Intensiva. 2011;35:552–561. doi: 10.1016/j.medin.2011.01.014.
    1. Nicolosi GL, Pungercic E, Cervesato E, Pavan D, Modena L, Moro E, Dall’Aglio V, Zanuttini D. Feasibility and variability of six methods for the echocardiographic and Doppler determination of cardiac output. Br Heart J. 1988;59:299–303. doi: 10.1136/hrt.59.3.299.
    1. Madhwal S, Yesenko S, Kim ESH, Park M, Begelman SM, Gornik HL. Manifestations of cardiac disease in carotid Duplex ultrasound examination. JACC. 2014;7:200–203.
    1. O’Boyle MK, Vibhakar NI, Chung J, Keen WD, Gosink BB. Duplex sonography of the carotid arteries in patients with isolated aortic stenosis: imaging findings and relation to severity of stenosis. AJR Am J Roentgenol. 1996;166:197–202. doi: 10.2214/ajr.166.1.8571875.
    1. Kallman C, Gosink B, Gardner D. Carotid duplex sonography: bisferious pulse contour in patients with aortic valvular disease. AJR Am J Roentgenol. 1991;157:403–407. doi: 10.2214/ajr.157.2.1853828.
    1. Kelsey JL, Whittemore AS, Evans AS, Thompson WD. Methods in observational epidemiology. New York: Oxford University Press Inc; 1996.
    1. Lee AJ, Cohn JH. Ranasinghe JS (2011) Cardiac output assessed by invasive and minimally invasive techniques. Anesthesiol Res Pract. 2011;17:475151.
    1. Marino PL. The ICU Bok. 4. Philadelphia: Lippincott Williams & Wilkins; 2014.

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