Emergency department non-invasive cardiac output study (EDNICO): a feasibility and repeatability study

D McGregor, S Sharma, S Gupta, S Ahmad, T Godec, Tim Harris, D McGregor, S Sharma, S Gupta, S Ahmad, T Godec, Tim Harris

Abstract

Background: There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assessed six non-invasive fluid responsiveness monitoring methods which measure cardiac output directly or indirectly for their feasibility and repeatability of measurements in the ED: (1) left ventricular outflow tract echocardiography derived velocity time integral, (2) common carotid artery blood flow, (3) suprasternal aortic Doppler, (4) bioreactance, (5) plethysmography with digital vascular unloading method, and (6) inferior vena cava collapsibility index.

Methods: This is a prospective observational study of non-invasive methods of assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Feasibility of each method was determined by the proportion of clinically interpretable measurements from the number of measurement attempts. Repeatability was determined by comparing the mean difference of two paired measurements in a fluid steady state (after participants received an intravenous fluid bolus).

Results: 76 patients were recruited in the study. A total of 207 fluid responsiveness measurement sets were analysed. Feasibility rates were 97.6% for bioreactance, 91.3% for vascular unloading method with plethysmography, 87.4% for common carotid artery blood flow, 84.1% for inferior vena cava collapsibility index, 78.7% for LVOT VTI, and 76.8% for suprasternal aortic Doppler. The feasibility rates difference between bioreactance and all other methods was statistically significant.

Conclusion: Our study shows that non-invasive fluid responsiveness monitoring in the emergency department may be feasible with selected methods. Higher repeatability of measurements were observed in non-ultrasound methods. These findings have implications for further studies specifically assessing the accuracy of such non-invasive cardiac output methods and their effect on patient outcome in the ED in fluid depleted states such as sepsis.

Keywords: Bioreactance; Fluid responsiveness; Plethysmography; Sepsis; Stroke volume; Ultrasound.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the NRES Committee East of England - Essex.

Study reference 15/EE/0227

Consent for publication

All participants consented for study data to be published

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study participant pathway. SV = stroke volume; CO = cardiac output; PVUT = plethysmography vascular unloading technique; CCABF = common carotid artery blood flow; IVCCI = inferior vena cava collapsibility index; LVOT VTI = left ventricular outflow tract velocity time integral; SSAD = suprasternal aortic Doppler
Fig. 2
Fig. 2
Quality assessment criteria for LVOT VTI, CCABF, SSAD and IVCCI
Fig. 3
Fig. 3
Collection of results
Fig. 4
Fig. 4
Mean time to completion of M1 for each method (minutes)
Fig. 5
Fig. 5
Mean difference between post-fluid measurements M2 and M3

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