Emergency Department Non-invasive Cardiac Output Study (EDNICO): an Accuracy Study

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2020 Feb 2

PMID 32005274

Citations 5

Authors

David McGregor

Shrey Sharma

Saksham Gupta

Shanaz Ahmed

Tim Harris

Affiliations

Soon will be listed here.

Abstract

Background: There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assess here the accuracy of five non-invasive methods in detecting fluid responsiveness in the ED: (1) common carotid artery blood flow, (2) suprasternal aortic Doppler, (3) bioreactance, (4) plethysmography with digital vascular unloading method, and (5) inferior vena cava collapsibility index. Left ventricular outflow tract echocardiography derived velocity time integral is the reference standard. This follows an assessment of feasibility and repeatability of these methods in the same cohort of ED patients.

Methods: This is a prospective observational study of non-invasive methods for assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Sensitivity and specificity of each method in determining the fluid responsiveness status of participants is determined in comparison to the reference standard.

Results: Thirty-three patient data sets were included for analysis. The specificity and sensitivity to detect fluid responders was 46.2 and 45% for common carotid artery blood flow (CCABF), 61.5 and 63.2% for suprasternal artery Doppler (SSAD), 46.2 and 50% for bioreactance, 50 and 41.2% for plethysmography vascular unloading technique (PVUT), and 63.6 and 47.4% for inferior vena cava collapsibility index (IVCCI), respectively. Analysis of agreement with Cohen's Kappa - 0.08 for CCABF, 0.24 for SSAD, - 0.04 for bioreactance, - 0.08 for PVUT, and 0.1 for IVCCI.

Conclusion: In this study, non-invasive methods were not found to reliably identify fluid responders. Non-invasive methods of identifying fluid responders are likely to play a key role in improving patient outcome in the ED in fluid depleted states such as sepsis. These results have implications for future studies assessing the accuracy of such methods.

Citing Articles

Questioning the Role of Carotid Artery Ultrasound in Assessing Fluid Responsiveness in Critical Illness: A Systematic Review and Meta-Analysis.

Walker S, Lipszyc A, Kilmurray M, Wilding H, Akhlaghi H Crit Care Res Pract. 2024; 2024:9102961.

PMID: 38716052 PMC: 11074915. DOI: 10.1155/2024/9102961.

The Utility of Echocardiography in Estimating Fluid Responsiveness.

Asogwa N, Assaad M, Ling J, Wahbah Makhoul G, El Hage H J Clin Med Res. 2024; 16(4):129-132.

PMID: 38715562 PMC: 11073387. DOI: 10.14740/jocmr5114.

Diagnostic Adjunct Techniques in the Assessment of Hypovolemia: A Prospective Pilot Project.

Ladha P, Truong E, Kanuika P, Allan A, Kishawi S, Ho V J Surg Res. 2023; 293:1-7.

PMID: 37690381 PMC: 11334708. DOI: 10.1016/j.jss.2023.08.005.

Diagnostic Accuracy of Ultrasonographic Respiratory Variation in the Inferior Vena Cava, Subclavian Vein, Internal Jugular Vein, and Femoral Vein Diameter to Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis.

Kim D, Chung S, Kang W, Kim J Diagnostics (Basel). 2022; 12(1).

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Early hemodynamic assessment using NICOM in patients at risk of developing Sepsis immediately after emergency department triage.

Chukwulebe S, Gaieski D, Bhardwaj A, Mulugeta-Gordon L, Shofer F, Dean A Scand J Trauma Resusc Emerg Med. 2021; 29(1):23.

PMID: 33509242 PMC: 7842048. DOI: 10.1186/s13049-021-00833-1.

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