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Stroke volume equation for impedance cardiography

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Abstract

The study's goal was to determine if cardiac output (CO), obtained by impedance cardiography (ICG), would be improved by a new equation N, implementing a square root transformation for dZ/dtmax/Z0, and a variable magnitude, mass-based volume conductor Vc. Pulmonary artery catheterisation was performed on 106 cardiac surgery patients pre-operatively. Post-operatively, thermodilution cardiac output (TDCO) was simultaneously compared with ICG CO. dZ/dtmax/Z0 and Z0 were obtained from a proprietary bioimpedance device. The impedance variables, in addition to left ventricular ejection time TLVE and patient height and weight, were input using four stroke volume (SV) equations: Kubicek (K), Sramek (S), Sramek-Bernstein (SB), and a new equation N. CO was calculated as SV × heart rate. Data are presented as mean ± SD. One way repeated measures of ANOVA followed by the Tukey test were used for inter-group comparisons. Bland-Altman methods were used to assess bias, precision and limits of agreement. P<0.05 was considered statistically significant. CO implementing N (6.06±1.48 l min−1) was not different from TDCO (5.97±1.41 l min−1). By contrast, CO calculated using K (3.70±1.53 l min−1), S (4.16±1.83 l min−1) and SB (4.37±1.82 l min−1) was significantly less than TDCO. Bland-Altman analysis showed poor agreement between TDCO and K, S and SB, but not between TDCO and N. Compared with TDCO, equation N, using a square-root transformation for dZ/dtmax/Z0, and a mass-based VC was superior to existing transthoracic impedance techniques for SV and CO determination.

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Authors and Affiliations

  1. Department of Anesthesiology, Palomar Medical Center, Escondido, CA, USA

    D. P. Bernstein

  2. Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA

    H. J. M. Lemmens

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  1. D. P. Bernstein
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  2. H. J. M. Lemmens
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Correspondence to D. P. Bernstein.

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Bernstein, D.P., Lemmens, H.J.M. Stroke volume equation for impedance cardiography. Med. Biol. Eng. Comput. 43, 443–450 (2005). https://doi.org/10.1007/BF02344724

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