Extracorporeal Arteriovenous Ultrasound Measurement of Cardiac Output in Small Children

Theodor S. Sigurdsson, M.D.; Anders Aronsson, M.D.; Lars Lindberg, M.D., Ph.D.


Anesthesiology. 2019;130(5):712-718. 

In This Article


A total of 47 children were enrolled in the study. Four children were excluded before surgery: one because of hemodynamic instability; another because an ultrasound sensor came loose underneath the surgical drape; and two because the internal calibration date for the tested device had expired, and the monitor refused to accept data. This resulted in 43 children being included in the study, in which a total of 215 paired COUD and COPVFP measurements were performed (Table 1). Mean age was 356 days (range, 30 to 1,303 days); mean weight was 7.1 kg (range, 2.7 to 13.6 kg); and mean body surface area was 0.36 m2 (range, 0.18 to 0.59 m2). There were no missing data from the included children.

The mean COUD was 1.28 l/min (range, 0.46 to 2.98 l/min) and COPVFP 1.20 l/min (range, 0.42 to 2.70 l/min). Means and SDs were normally distributed. The coefficient of error for repeated COUD measurements was 1.8%, resulting in precision of 3.6% for COUD. Coefficient of error for COPVFP was 2.5%, resulting in precision of 5.0% for COPVFP.

Bland–Altman analysis (Figure 3) showed that the bias between COUD and COPVFP was 0.08 l/min (95% CI, 0.05 to 0.10), and the limits of agreement were −0.24 l/min (95% CI, −0.17 to −0.32) and 0.40 l/min (95% CI, 0.33 to 0.47). The percentage error between COUD and COPVFP was 26.6%.

Figure 3.

Bland–Altman plot comparing different methods for cardiac output (CO) measurement, saline dilution and ultrasound detection (COUD), and perivascular flow probe (COPVFP). LOA, limits of agreement.

Three patients had insignificant residual shunts after the surgical correction. No valvular regurgitations were observed that affected the results. There were no adverse effects in any patient related to measurements.