Abstract
Background
The bioreactance technique is a relatively new, totally noninvasive technique that
is used to measure cardiac output (CO) and is easy to use. The Non-Invasive Cardiac
Output Monitor (NICOM) is 1 such system. Although approved by the Food and Drug Administration
for measurement of stroke volume, there is a paucity of literature validating this
technology in decompensated heart failure and cardiogenic shock.
Methods and Results
Fifty patients admitted to our cardiac intensive care unit for cardiogenic shock and
Swan-Ganz catheter-guided therapy were prospectively enrolled in the study after informed
consent. Simultaneous measurements of CO were obtained using NICOM, indirect Fick
and bolus thermodilution. The intraclass correlation coefficient (ICC) was used to
assess the precision of NICOM for CO using the 3 repeated measurements of CO over
the pooled data. The agreement of the NICOM device in the defined clinical population,
compared to indirect Fick and thermodilution, was evaluated by comparing the Pearson
correlation coefficient, the Bland-Altman plot and the Lin concordance correlation
coefficient. The ICC for cardiac output measured by NICOM showed excellent repeatability
(ICC = 0.93, 95% CI = 0.92–0.94, n = 262) in the pooled data. The Pearson correlation
coefficient for cardiac output measured by NICOM was poor when compared to indirect
Fick (n = 263, r = 0.132, P = 0.033) and TD (n = 258, r = 0.275, P < 0.001).
Conclusions
NICOM technology is not a reliable method of measuring CO in patients with decompensated
heart failure and cardiogenic shock.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic and PersonalCorporate R&D ProfessionalsOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiac FailureAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness: the ESCAPE trial.JAMA. 2005; 294: 1625-1633
- Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials.JAMA. 2005; 294: 1664-1670
- Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients.Crit Care Med. 1984; 12: 549-553
- Pulmonary artery catheterization in critically ill patients: a prospective analysis of outcome changes associated with catheter-prompted changes in therapy.Crit Care Med. 1994; 22: 573-579
- American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation. 2013; 128: e240-e327
- Evaluation of a noninvasivecontinuous cardiac output monitoring system based on thoracicbioreactance.Am J Physiol Heart Circ Physiol. 2007; 293: H583-H589
- Noninvasive cardiac output monitoring (NICOM): a clinical validation.Intensive Care Med. 2007; 33: 1191-1194
- Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique.J Clin Monit Comput. 2008; 22: 113-119
- Noninvasive assessment of acute dyspnea in the ED.Chest. 2013; 144: 610-615
- Noninvasive cardiac output measurements in patients with pulmonary hypertension.Eur Respir J. 2013; 42: 125-133
- Cardiac output measurements using the bioreactance technique in critically ill patients.Crit Care. 2012; 16: 460
- Methods for evaluating the agreement between diagnostic tests.J Nuclear Cardiol. 2016; 23: 511-513
Article Info
Publication History
Published online: November 18, 2019
Accepted:
November 13,
2019
Received in revised form:
October 13,
2019
Received:
July 12,
2019
Footnotes
Funding: Our study was funded through the Heart Failure Research grant # 40541 at The University of Kansas Medical Center .
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
