Cardiac Output Measurement by TEE
| Status: | Recruiting |
|---|---|
| Conditions: | Peripheral Vascular Disease, Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/22/2018 |
| Start Date: | August 1, 2017 |
| End Date: | December 1, 2018 |
| Contact: | Massimiliano Meineri, MD |
| Email: | massimiliano.meineri@uhn.ca |
| Phone: | 416-340-4800 |
Intraoperative Measurement of Cardiac Output During Cardiac Surgery: Which TEE Method is Best?
Transesophageal echocardiography (TEE) has become a standard monitoring tool during cardiac
surgery. It allows continuous accurate assessment of heart structures and function without
interfering with the surgery and the anesthetics. The imaging of cardiac structures is used
to direct optimal surgical intervention and assess surgical results. Cardiac output (CO) is
the result of stroke volume (SV) multiplied by the heart rate.
Measurement of cardiac output (CO) is used to quantify the performance of the left ventricle.
It is commonly achieved using a pulmonary artery catheter (PAC) (also known ad Swann-Ganz
catheter). A known amount of saline solution is injected in the proximal part of the catheter
and the variation of blood temperature detected at the tip. Cardiac output is measured based
on the duration and degree of temperature change. This method remains an accepted gold
standard. TEE allows measurement of cardiac output using a number of different 2D and 3D
imaging modalities. Although current guidelines identify the Method of the Disks(MOD) as the
gold standard other technique could potentially be more precise. In this study, the
investigators want to assess the accuracy of four different TEE methods to measure cardiac
output compared with Thermodilution as a standard of care.
surgery. It allows continuous accurate assessment of heart structures and function without
interfering with the surgery and the anesthetics. The imaging of cardiac structures is used
to direct optimal surgical intervention and assess surgical results. Cardiac output (CO) is
the result of stroke volume (SV) multiplied by the heart rate.
Measurement of cardiac output (CO) is used to quantify the performance of the left ventricle.
It is commonly achieved using a pulmonary artery catheter (PAC) (also known ad Swann-Ganz
catheter). A known amount of saline solution is injected in the proximal part of the catheter
and the variation of blood temperature detected at the tip. Cardiac output is measured based
on the duration and degree of temperature change. This method remains an accepted gold
standard. TEE allows measurement of cardiac output using a number of different 2D and 3D
imaging modalities. Although current guidelines identify the Method of the Disks(MOD) as the
gold standard other technique could potentially be more precise. In this study, the
investigators want to assess the accuracy of four different TEE methods to measure cardiac
output compared with Thermodilution as a standard of care.
The measurement of the LV performance, as reflected by measuring cardiac output (CO), is an
important component of hemodynamic assessment during cardiac (and non-cardiac) surgery. It
has become standard of care in guiding fluid management and inotropic therapy in both the
operating room (OR) and the intensive care unit (ICU) in most centres, and is considered by
far the most understood and commonly communicated parameter of cardiac performance, in
addition to being consistently shown as a predictor of patients' outcome.
Several methods have been used to measure CO. The most commonly used is via thermodilution
(PAC), but its invasive nature and potential for serious complications led to the utilization
of the non-invasive methods, such as those based on TEE.
Since the establishment of the role of TEE in the setting of hemodynamic monitoring during
cardiac surgery, various ways of quantifying LV function have been utilized. The method
recommended by current guidelines is a volumetric calculation via the method of disks
(modified Simpson's method, MOD). Recent advances in ultrasound technology and software
development allow the utilization three-dimensional (3D) volumetric assessment and speckle
tracking for cardiac deformation.
important component of hemodynamic assessment during cardiac (and non-cardiac) surgery. It
has become standard of care in guiding fluid management and inotropic therapy in both the
operating room (OR) and the intensive care unit (ICU) in most centres, and is considered by
far the most understood and commonly communicated parameter of cardiac performance, in
addition to being consistently shown as a predictor of patients' outcome.
Several methods have been used to measure CO. The most commonly used is via thermodilution
(PAC), but its invasive nature and potential for serious complications led to the utilization
of the non-invasive methods, such as those based on TEE.
Since the establishment of the role of TEE in the setting of hemodynamic monitoring during
cardiac surgery, various ways of quantifying LV function have been utilized. The method
recommended by current guidelines is a volumetric calculation via the method of disks
(modified Simpson's method, MOD). Recent advances in ultrasound technology and software
development allow the utilization three-dimensional (3D) volumetric assessment and speckle
tracking for cardiac deformation.
Inclusion Criteria:
- age >18
- undergoing elective CABG, AV or aortic surgery (aortic root and ascending aortic arch
surgery), with CPB.
Exclusion Criteria:
- Emergency surgery
- Moderate or severe valve pathology
- Atrial fibrillation
- Patients with known contraindications to either the insertion of a PAC or the use of
TEE.
We found this trial at
2
sites
399 Bathurst Street
Toronto, Ontario M5T 2S8
Toronto, Ontario M5T 2S8
Principal Investigator: Massimiliano Meineri, MD
Phone: 4163404800
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