title: Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: a systematic review and meta-analysis†.
abstract: Cardiac output (CO) measurement is crucial for the guidance of therapeutic decisions in critically ill and high-risk surgical patients. Newly developed completely non-invasive CO technologies are commercially available; however, their accuracy and precision have not recently been evaluated in a meta-analysis. We conducted a systematic search using PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science to review published data comparing CO measured by bolus thermodilution with commercially available non-invasive technologies including pulse wave transit time, non-invasive pulse contour analysis, thoracic electrical bioimpedance/bioreactance, and CO2 rebreathing. The non-invasive CO technology was considered acceptable if the pooled estimate of percentage error was <30%, as previously recommended. Using a random-effects model, sd, pooled mean bias, and mean percentage error were calculated. An I2 statistic was also used to evaluate the inter-study heterogeneity. A total of 37 studies (1543 patients) were included. Mean CO of both methods was 4.78 litres min−1. Bias was presented as the reference method minus the tested methods in 15 studies. Only six studies assessed the random error (repeatability) of the tested device. The overall random-effects pooled bias (limits of agreement) and the percentage error were −0,13 [−2.38 , 2.12] litres min−1 and 47%, respectively. Inter-study sensitivity heterogeneity was high (I2=83%, P<0.001). With a wide percentage error, completely non-invasive CO devices are not interchangeable with bolus thermodilution. Additional studies are warranted to demonstrate their role in improving the quality of care.
authors.affiliation: Department of Anesthesiology, CUB Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennick, 1070 Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Joosten
authors.affiliation: Department of Anesthesiology and Critical Care, Clinique de la Sauvegarde, Lyon, France.
authors.forename: O
authors.initials: O
authors.lastname: Desebbe
authors.affiliation: Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Suehiro
authors.affiliation: Ayala Science Library Reference Department, University of California, Irvine, CA, USA.
authors.forename: L S-L
authors.initials: LS
authors.lastname: Murphy
authors.affiliation: Department of Anesthesiology and Perioperative Care, University of California Irvine, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Essiet
authors.affiliation: Department of Anesthesiology, University of California San Diego, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Alexander
authors.affiliation: CHU de Caen, Pôle Réanimations Anesthésie SAMU/SMUR, Avenue de la Côte de Nacre, CS 30001, Caen, F-14 000, France.|EA 4650, Université de Caen Basse-Normandie, Esplanade de la Paix, CS 14 032, Caen, F-14 000, France.
authors.forename: M-O
authors.initials: MO
authors.lastname: Fischer
authors.affiliation: Department of Anesthesiology, CUB Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennick, 1070 Brussels, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Barvais
authors.affiliation: Department of Anesthesiology, CUB Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennick, 1070 Brussels, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Van Obbergh
authors.affiliation: Department of Biostatistics, Hospices Civils de Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cannesson
mesh_terms: D002302:Cardiac Output; D006801:Humans; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D019990:Perioperative Care / Q000295:instrumentation* / Q000379:methods*; D015203:Reproducibility of Results