Monitoring in resuscitation: Comparison of cardiac output measurement between pulmonary artery catheter and NICO☆

Abstract 

Aim

The cardiac output and coronary perfusion pressure generated from chest compressions during resuscitation manoeuvres can predict effectiveness and successful outcome. Until now, there is no good method for haemodynamic monitoring during resuscitation. Noninvasive partial carbon dioxide rebreathing system (NICO, Novametrix Medical Systems, Inc., Wallingford, CT, USA) is a relatively new non-invasive alternative to thermodilution for measuring cardiac output. The accuracy of the NICO system has not been evaluated during resuscitation. The aim of this study is to compare thermodilution cardiac output method with NICO system and to assess the utility of NICO during resuscitation.

Methods and design

Experimental study in 24 Yorkshire pigs.

Paired measurements of cardiac output were determined during resuscitation (before ventricular fibrillation and after 5, 15, 30 and 45min of resuscitation) in the supine position. The average of 3 consecutive thermodilution cardiac output measurements (10ml 20°C saline) was compared with the corresponding NICO measurement.

Results

Bland and Altman plot and Lin's concordance coefficient showed a high correlation between NICO and thermodilution cardiac output measurements although NICO has a tendency to underestimate cardiac output when compared to thermodilution at normal values of cardiac output.

Conclusions

There is a high degree of agreement between cardiac output measurements obtained with NICO and thermodilution cardiac output during resuscitation.

The present study suggests that the NICO system may be useful to measure cardiac output generated during cardiopulmonary resuscitation.

Keywords: Cardiac output, Cardiopulmonary resuscitation, Haemodynamics, Circulation, Monitoring