Department of Intensive Care, Service de Réanimation Polyvalente, Centre Hospitalier de Narbonne, Bd Dr Lacroix, F-11100 Narbonne, France.
Br J Anaesth. 2012 Dec;109(6):879-86. doi: 10.1093/bja/aes298. Epub 2012 Aug 19.
The esCCO monitor (ECG- estimated Continuous Cardiac Output, Nihon Kohden(®)) is a new non-invasive tool for estimating cardiac output (CO). It derives CO from the pulse wave transit time (PWTT) estimated by the ECG and the plethysmographic wave. An initial calibration is needed to refine the relation linking pulse pressure (measured by arterial pressure cuff) to PWTT. To assess the accuracy and reliability of the esCCO system, we performed an analysis of agreement of CO values obtained by transthoracic echocardiography (TTE).
Thirty-eight intensive care unit patients were prospectively included. CO was determined simultaneously using esCCO (CO(esCCO)) and TTE (CO(TTE)) as our reference method.
A total of 103 paired readings from 38 patients were collected. The correlation coefficient between CO(esCCO) and CO(TTE) was 0.61 (P<0.001). The Bland and Altman analysis corrected for repeated measures showed a bias of -1.6 litre min(-1) and limits of agreement from -4.7 to +1.5 litre min(-1), with a percentage error (2 sd/mean CO) of 49%. The correlation for CO changes was significant (R=0.63, P<0.001), but the concordance rate was poor (73%). Polar plot analysis showed an angular bias of -9° with radial limits of agreement from -54° to +36°. The bias appeared to correlate with systemic vascular resistance (R=-0.45, P<0.001).
In critically ill patients, the performance of the esCCO monitor was not clinically acceptable, and this monitor cannot be recommended in this setting. Moreover, the esCCO failed to trend CO data reliably.
esCCO 监测仪（ECG- 估计连续心输出量，尼森高登（®））是一种新的非侵入性工具，用于估计心输出量（CO）。它通过心电图和容积描记波估计的脉搏波传导时间（PWTT）来计算 CO。需要初始校准来改进将脉搏压（通过动脉血压袖带测量）与 PWTT 相关联的关系。为了评估 esCCO 系统的准确性和可靠性，我们对通过经胸超声心动图（TTE）获得的 CO 值进行了一致性分析。
前瞻性纳入 38 例重症监护病房患者。使用 esCCO（CO（esCCO））和 TTE（CO（TTE））同时确定 CO，后者为我们的参考方法。
从 38 例患者中总共收集了 103 对读数。CO（esCCO）和 CO（TTE）之间的相关系数为 0.61（P<0.001）。针对重复测量进行校正的 Bland 和 Altman 分析显示，偏倚为-1.6 升/分钟，一致性界限为-4.7 至+1.5 升/分钟，误差百分比（2 sd/平均 CO）为 49%。CO 变化的相关性显著（R=0.63，P<0.001），但一致性率较差（73%）。极坐标图分析显示，角度偏倚为-9°，径向一致性界限为-54°至+36°。偏倚似乎与全身血管阻力相关（R=-0.45，P<0.001）。
在危重病患者中，esCCO 监测仪的性能不能满足临床要求，因此不能在此环境中推荐该监测仪。此外，esCCO 无法可靠地监测 CO 数据的趋势。
