Coté Charles J, Sui Jinghu, Anderson Thomas Anthony, Bhattacharya Somaletha T, Shank Erik S, Tuason Pacifico M, August David A, Zibaitis Audrius, Firth Paul G, Fuzaylov Gennadiy, Leeman Michael R, Mai Christine L, Roberts Jesse D
Division of Pediatric Anesthesia, Department of Anesthesia, Critical and Pain Management, MassGeneral Hospital for Children, Massachusetts General Hospital, Boston, MA, USA.
Paediatr Anaesth. 2015 Feb;25(2):150-9. doi: 10.1111/pan.12441. Epub 2014 Jun 10.
Electrical Cardiometry(™) (EC) estimates cardiac parameters by measuring changes in thoracic electrical bioimpedance during the cardiac cycle. The ICON(®), using four electrocardiogram electrodes (EKG), estimates the maximum rate of change of impedance to peak aortic blood acceleration (based on the premise that red blood cells change from random orientation during diastole (high impedance) to an aligned state during systole (low impedance)).
To determine whether continuous cardiac output (CO) data provide additional information to current anesthesia monitors that is useful to practitioners.
After IRB approval and verbal consent, 402 children were enrolled. Data were uploaded to our anesthesia record at one-minute intervals. Ten-second measurements (averaged over the previous 20 heart beats) were downloaded to separate files for later comparison with routine OR monitors.
Data from 374 were in the final cohort (loss of signal or improper lead placement); 292,012 measurements during 58,049 min of anesthesia were made in these children (1 day to 19 years and 1 to 107 kg). Four events had a ≥25% reduction in cardiac index at least 1 min before a clinically important change in other monitored parameters; 18 events in 14 children confirmed manifestations of other hemodynamic measures; eight events may have represented artifacts because the observed measurements did not seem to fit the clinical parameters of the other monitors; three other events documented decreased stroke index with extreme tachycardia.
Electrical cardiometry provides real-time cardiovascular information regarding developing hemodynamic events and successfully tracked the rapid response to interventions in children of all sizes. Intervention decisions must be based on the combined data from all monitors and the clinical situation. Our experience suggests that this type of monitor may be an important addition to real-time hemodynamic monitoring.
心脏电测法（Electrical Cardiometry™，EC）通过测量心动周期中胸壁生物电阻抗的变化来估算心脏参数。ICON® 使用四个心电图电极（EKG），基于红细胞在舒张期（高阻抗）从随机取向转变为收缩期（低阻抗）的对齐状态这一前提，估算阻抗变化至主动脉血流加速度峰值的最大速率。
确定连续心输出量（CO）数据是否能为当前麻醉监测仪提供对从业者有用的额外信息。
经机构审查委员会（IRB）批准并获得口头同意后，招募了402名儿童。数据以一分钟的间隔上传至我们的麻醉记录中。将十秒的测量值（对前20次心跳进行平均）下载到单独的文件中，以便日后与手术室常规监测仪进行比较。
最终队列中有374名儿童的数据（信号丢失或导联放置不当）；这些儿童在58049分钟的麻醉过程中进行了292012次测量（年龄从1天至19岁，体重从1至107千克）。在其他监测参数出现临床重要变化前至少1分钟，有4次事件的心指数降低了≥25%；14名儿童中的18次事件证实了其他血流动力学指标的表现；8次事件可能代表伪像，因为观察到的测量值似乎不符合其他监测仪的临床参数；另外3次事件记录了伴有极度心动过速的每搏输出量降低。
心脏电测法提供了有关血流动力学事件发展的实时心血管信息，并成功跟踪了所有年龄段儿童对干预措施的快速反应。干预决策必须基于所有监测仪的综合数据以及临床情况。我们的经验表明，这种类型的监测仪可能是实时血流动力学监测的重要补充。
