Abstract 12131: Comparison of Ultrasonic Cardiac Output Monitor (USCOM) With Other Methods for Cardiac Output Monitoring in Various Clinical Settings and Clinical Outcomes and Costs: A Systematic Review and Meta-Analysis

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A12131
• Main Authors: Elfaituri, Muhammed K, Vuong, Nguyen Lam, Low, Soon Khai, El-Sayed, Mariam, Lakhani, Midhat L, Istanbuly, Sedralmontaha, Sharma, Akash, Muhammad, Samar, Tuan, Tran Thanh, Hou, Vincent, Farahat, Samar Tarek, Eladely, Ahmed, Huy, Nguyen Tien, Salman Faisal, Muhammad
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06.11.2018
• ISSN: 0009-7322; 1524-4539

IntroductionCardiac output (CO) measurement and monitoring is crucial for the guidance of diagnostic and therapeutic decisions clinically, especially in cardiology, critically ill and surgical patients. There are many devices that can be employed to monitor CO, including invasive and non-invasive monitoring. Ultrasonic cardiac output monitor (USCOM Ltd., Sydney, Australia) is among one of the non-invasive CO monitoring devices that are being used increasingly. However, data on the accuracy and precision of USCOM when compared to other established standard CO monitoring devices are insufficient.HypothesisThe objectives of this systematic review are to assess the different applications of USCOM in various clinical settings, and to evaluate its accuracy and precision in measuring cardiac output compared to other reference methods.MethodsWe conducted a systematic search using PubMed, Cochrane Library of Clinical Trials, Scopus, Web of Science, Google scholar, EMBASE, GHL, POPLINE, VHL and SIGLE to review published data comparing CO measured and monitored by USCOM and other widely used well-established invasive CO monitoring technologies such as bolus thermodilution. USCOM was considered an acceptable alternative 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 I statistic was also used to evaluate the inter-study heterogeneity. The methodological quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The study protocol has been registered in PROSPERO with registration number CRD42018087291.ResultsA total of 22 studies (844 patients) were included. Mean CO of both methods was 5.29 liters min. Bias was presented as the reference method minus the tested methods in 16 studies. The overall random-effects pooled bias (limits of agreement) and the percentage error were 0.37 [-1.65; 2.40] liters min and 38%, respectively. Inter-study sensitivity heterogeneity was high (I2=95%, P<0.001).ConclusionsThe percentage error for USCOM against standard reference method for CO monitoring was beyond the clinically acceptable limit of 30%. Thereby USCOM may not be as reliable as an alternative to the standard reference method such as bolus thermodilution CO monitoring. Additional studies are warranted to provide evidence and support the use of USCOM.