Using Electrical Cardiometry For Noninvasive Hemodynamic Monitoring In Patients Managed With Extracorporeal Membrane Oxygenation.

Abstract

Background: An early correction of shock state and tissue hypoperfusion at a proper time is important before the occurrence of irreversible shock.  

An extracorporeal membrane oxygenation (ECMO) patient requires strict hemodynamics follow up.

Objective: This study was conducted to evaluate electrical cardiometry (ICON™) in stroke volume (SV), cardiac output (CO) and cardiac contractility measurement using transthoracic echocardiography in ECMO patients

Patients and methods: The study is a prospective cross-sectional study on ten adult patients eligible to ECMO (both venoarterial V-A and venovenous V-V ECMO). ICON™ was utilized to assess hemodynamics. SV, CO and index of contractility (ICON parameter reflecting contractility) were estimated using electrical cardiometry and compared to transthoracic echocardiography.

- CO was estimated using electrical cardiometry (ICON OSYPKA medical, Germany) using bioimbedance technology through 4 electrodes connected to the left side of the body with good signal quality for accuracy of measurements {signal quality indicator (SQI) ranging from 70 to 100}

- Echocardiography measurements were taken using Pulsed Wave (PW) doppler over left ventricular outflow track (LVOT) (2-3 cm away from aortic valve in apical three or five chamber views) to calculated LVOT Velocity Time Integral (LVOT VTI).

- Stroke Volume (SV) = LVOT VTI × Cross sectional area (CSA) of LVOT (calculated from parasternal long axis 0.5 cm from aortic valve).

- CՕ = SV × Heart Rate (HR)

- EF was calculated by echocardiography using M-mode

- The two measurements were taken at the same time in 10 patients treated with ECMO (6 patients were connected on VV ECMO (675 paired values) and remaining 4 patients on VA ECMO (343 paired values)

- In VV ECMO patients, CO calculated by echocardiography and estimated by ICON equal native CO

- While CO estimated by ICON in VA ECMO patients equals native CO measured by echocardiography and ECMO flow.

Results: There was statistically significance correlation between SV and CO estimated with ICON™ compared to echocardiography in patients connected to VV ECMO and CO estimated using ICON™ and total cardiac output in patients connected to VA ECMO.

In both groups there was statistically significance correlation between cardiac contractility estimated by ICON™ and EF calculated by echocardiography.

Conclusion: ICON™ can be used to monitor SV, CO and cardiac contractility in patients connected to ECMO.