Validation of a new method based on ultrasound velocity dilution to measure cardiac output in paediatric patients

Intensive Care Med. 2013 May;39(5):926-33. doi: 10.1007/s00134-013-2848-5. Epub 2013 Feb 22.


Purpose: To validate a novel method of ultrasound dilution (COstatus(®); Transonic Systems, Ithaca, NY) for measuring cardiac output in paediatric patients after biventricular repair of congenital heart disease.

Methods: Children undergoing biventricular repair of congenital heart disease were prospectively identified. Patients with significant intracardiac shunts were excluded. Postoperative cardiac output was measured by ultrasound dilution (COud) and concurrently calculated by the Fick equation (COrms) using measured oxygen consumption by respiratory mass spectrometry.

Results: Thirty-five patients were studied generating 66 individual data sets. Subjects had a median (interquartile range) age of 147 days (11, 216), weight of 4.98 kg (3.78, 6.90) and body surface area of 0.28 m(2) (0.22, 0.34). Of the patients, 66% had peripheral arterial catheters and 34% had femoral cannulation; peripheral arterial lines accounted for 6/8 of unsuccessful studies due to inability to generate sufficient flow. The site of the central venous cannula did not impact the feasibility of completing the study. A mean bias of 0.00 L/min [2 standard deviation (SD) ± 0.76 L/min] between COud and COrms was found with a percentage error of 97%. When comparing cardiac index, bias increased to 0.13 L/min/m(2) (2SD ± 2.16 L/min/m(2)).

Conclusions: Cardiac output by ultrasound dilution showed low bias with wide limits of agreement when compared to measurement derived by the Fick equation. Although measurements through central and peripheral arterial lines were completed with minimal difficulties in the majority of patients, the application of COstatus(®) in neonates with low body surface area may be limited.

Publication types

  • Validation Study

MeSH terms

  • Blood Flow Velocity
  • Cardiac Output / physiology*
  • Equipment Design
  • Female
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Heart Function Tests
  • Humans
  • Indicator Dilution Techniques / instrumentation*
  • Infant
  • Infant, Newborn
  • Male
  • Mass Spectrometry
  • Oxygen Consumption / physiology
  • Prospective Studies
  • Ultrasonography