Automated cardiac output measurements by ultrasound are inaccurate at high cardiac outputs

Objective The sonographic technique of automated cardiac output measurement (ACM) is a promising new method to measure cardiac output and could be of use in a high-risk obstetric unit in the treatment of pre-eclamptic patients. The aim was to determine the accuracy of the ACM method. Design Comparative study of the sonographic technique of ACM versus cardiac output measured by thermodilution (TD). Methods The study included 39 intensive care patients, 21 men, 13 non-pregnant women and five severely pre-eclamptic pregnant patients, with a wide range of cardiac outputs, in whom TD catheters had been inserted for clinical reasons. Two separate experienced observers, blinded to the results obtained with the other method, performed four successive measurements in each patient with either the ACA-I or TD technique. The averaged cardiac output value per patient and method tons used for comparison. Results Cardiac output was successfully measured with ACM and TD in 85 and 100% of patients, respectively. Mean cardiac output measured by ACM (6.77 +/- 1.90 L/min) was significantly lower than that measured by TD (9.12 +/- 3.06 L/min). Although cardiac output values obtained with ACM were significantly correlated with those measured by TD, the ACM values were consistently lower than TD values in the higher cardiac output range; the relationship was represented by ACM = 0.35 TD + 3.55 L/min (r =0.57, P < 0.001). The (ACM - TD) difference increased significantly with cardiac output, through a difference in strobe volume, not in heart rate. Conclusion The ACM is not an accurate tool to measure cardiac output in patients with a high cardiac output, including treated pre-eclamptic women.