Reliability of thermodilution derived cardiac output with different operator characteristics

Scott C. McKenzie, Kimble Dunster, Wandy Chan, Martin R. Brown, David G. Platts, George Javorsky, Chris Anstey, Shaun D. Gregory

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Cardiac output (CO) is commonly measured using the thermodilution technique at the time of right heart catheterisation (RHC). However inter-operator variability, and the operator characteristics which may influence that, has not been quantified. Therefore, this study aimed to assess inter-operator variability with the thermodilution technique using a mock circulation loop (MCL) with calibrated flow sensors. Participants were blinded and asked to determine 4 levels of CO using the thermodilution technique, which was compared with the MCL calibrated flow sensors. The MCL was used to randomly generate CO between 3.0 and 7.0 L/min through changes in heart rate, contractility and vascular resistance with a RHC inserted through the MCL pulmonary artery. Participant characteristics including gender, specialty, age, height, weight, body-mass index, grip strength and RHC experience were recorded and compared to determine their relationship with CO measurement accuracy. In total, there were 15 participants, made up of consultant cardiologists (6), advanced trainees in cardiology (5) and intensive care consultants (4). The majority (9) had performed 26-100 previous RHCs, while 4 had performed more than 100 RHCs. Compared to the MCL-measured CO, participants overestimated CO using the thermodilution technique with a mean difference of +0.75 ± 0.71 L/min. The overall r2 value for actual vs measured CO was 0.85. The difference between MCL and thermodilution derived CO declined significantly with increasing RHC experience (P < 0.001), increasing body mass index (P < 0.001) and decreasing grip strength (P = 0.033). This study demonstrated that the thermodilution technique is a reasonable method to determine CO, and that operator experience was the only participant characteristic related to CO measurement accuracy. Our results suggest that adequate exposure to, and training in, the thermodilution technique is required for clinicians who perform RHC.

LanguageEnglish
Pages227–234
Number of pages8
JournalJournal of Clinical Monitoring and Computing
Volume32
Issue number2
Early online date9 Mar 2017
DOIs
Publication statusPublished - Apr 2018
Externally publishedYes

Fingerprint

Thermodilution
Cardiac Output
Cardiac Catheterization
Hand Strength
Consultants
Body Mass Index
Myocardial Contraction
Critical Care
Cardiology
Vascular Resistance
Pulmonary Artery
Heart Rate
Weights and Measures

Keywords

  • Cardiac output
  • Thermodilution
  • Pulmonary artery catheterisation
  • Clinical measurements
  • Measurement precision

Cite this

McKenzie, Scott C. ; Dunster, Kimble ; Chan, Wandy ; Brown, Martin R. ; Platts, David G. ; Javorsky, George ; Anstey, Chris ; Gregory, Shaun D. / Reliability of thermodilution derived cardiac output with different operator characteristics. In: Journal of Clinical Monitoring and Computing. 2018 ; Vol. 32, No. 2. pp. 227–234.
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abstract = "Cardiac output (CO) is commonly measured using the thermodilution technique at the time of right heart catheterisation (RHC). However inter-operator variability, and the operator characteristics which may influence that, has not been quantified. Therefore, this study aimed to assess inter-operator variability with the thermodilution technique using a mock circulation loop (MCL) with calibrated flow sensors. Participants were blinded and asked to determine 4 levels of CO using the thermodilution technique, which was compared with the MCL calibrated flow sensors. The MCL was used to randomly generate CO between 3.0 and 7.0 L/min through changes in heart rate, contractility and vascular resistance with a RHC inserted through the MCL pulmonary artery. Participant characteristics including gender, specialty, age, height, weight, body-mass index, grip strength and RHC experience were recorded and compared to determine their relationship with CO measurement accuracy. In total, there were 15 participants, made up of consultant cardiologists (6), advanced trainees in cardiology (5) and intensive care consultants (4). The majority (9) had performed 26-100 previous RHCs, while 4 had performed more than 100 RHCs. Compared to the MCL-measured CO, participants overestimated CO using the thermodilution technique with a mean difference of +0.75 ± 0.71 L/min. The overall r2 value for actual vs measured CO was 0.85. The difference between MCL and thermodilution derived CO declined significantly with increasing RHC experience (P < 0.001), increasing body mass index (P < 0.001) and decreasing grip strength (P = 0.033). This study demonstrated that the thermodilution technique is a reasonable method to determine CO, and that operator experience was the only participant characteristic related to CO measurement accuracy. Our results suggest that adequate exposure to, and training in, the thermodilution technique is required for clinicians who perform RHC.",
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McKenzie, SC, Dunster, K, Chan, W, Brown, MR, Platts, DG, Javorsky, G, Anstey, C & Gregory, SD 2018, 'Reliability of thermodilution derived cardiac output with different operator characteristics', Journal of Clinical Monitoring and Computing, vol. 32, no. 2, pp. 227–234. https://doi.org/10.1007/s10877-017-0010-6

Reliability of thermodilution derived cardiac output with different operator characteristics. / McKenzie, Scott C.; Dunster, Kimble; Chan, Wandy; Brown, Martin R.; Platts, David G.; Javorsky, George; Anstey, Chris; Gregory, Shaun D.

In: Journal of Clinical Monitoring and Computing, Vol. 32, No. 2, 04.2018, p. 227–234.

Research output: Contribution to journalArticleResearchpeer-review

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AU - McKenzie, Scott C.

AU - Dunster, Kimble

AU - Chan, Wandy

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AU - Anstey, Chris

AU - Gregory, Shaun D.

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