Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Ng CH(1), Cheng YW (1) Chan CN(2), Lam HS(2)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital
(2) Department of Paediatrics, Prince of Wales Hospital
Introduction :
The capability to continuously monitor cardiac output non-invasively would be invaluable in the management of neonates with hemodynamic compromise who require frequent adjustments in supportive care, volume administration and titration of vasoactive agents. Transthoracic echocardiography (TTE) has been the most frequently used tool for hemodynamic assessments in pediatric patients and with measurement validated to be comparable with those obtained by PAC thermodilution. Although it is non-invasive, the process is time consuming and continuous monitoring is impossible. In addition, echocardiography is operator-dependent, and measurements are only reliable when obtained by trained physicians.
Objectives :
Electrical Cardiometry (EC) (ICON®, Osypka Medical, Berlin, Germany) is a form of thoracic electrical bio-impedance (TEB) that is based on changes of the orientation of erythrocytes in the aorta during the cardiac cycle which allows continuous monitoring of cardiac output (CO). There have been limited studies of its use in the extremely premature neonates and term neonates requiring intensive care and ventilator support. We aim to evaluate the agreement of cardiac output measured with electrical cardiometry (EC)and transthoracic echocardiogram (TTE) in neonates across different weight ranges and different modalities of respiratory support.
Methodology :
In this prospective observational study, we obtained 178 simultaneous paired measurements of cardiac output in 49 neonates. Data were compared by correlation, Bland-Altman analysis, and two-way analysis of variance.
Result & Outcome :
Overall, the two methods showed a high correlation with the Pearson coefficient of 0.919 (p < 0.01). The bias (mean difference of the methods) and percentage error {100% × (1.96 × standard deviation of the difference between EC and TTE measurements)/average of the EC and TTE measurements} were + 40.4 ml/min and 30.3% respectively. There were higher percentages of errors for patients with patent ductus arteriosus (43%) and on high frequency oscillation ventilation (39%).
This study demonstrated a high overall correlation and clinically acceptable agreement between EC and TTE in critically ill neonates. Cautious interpretation would be needed in neonates with PDA or on HFOV.
