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Cardiac output determination during experimental hemorrhage and resuscitation using a transesophageal Doppler monitor

Introduction

Transesophageal Doppler (TED) has been considered a noninvasive and accurate alternative to pulmonary artery catheter for volume replacement and cardiac output measurement in patients undergoing major surgeries.

Objective

To test the hypothesis that TED can accurately predict cardiac output during hemorrhage, shock and resuscitation, by comparing it to total pulmonary artery blood flow (PABF), the gold standard for cardiac output estimation and to standard intermittent bolus cardiac output (ICO).

Methods

In eight anesthetized dogs (18 ± 1.0 kg), PABF was measured with an ultrasonic flowprobe while ICO and mixed venous O2 saturation (SvO2) were measured through a Swan-Ganz catheter. A TED probe (CardioQ™), designed for adult use (minimum 30 kg, 16 years), was placed in midesophageous to evaluate stroke volume. A graded hemorrhage (20 ml/min) was produced (H5–H35) to a mean arterial pressure (MAP) of 40 mmHg and maintained by additional blood removal for 30 min (S1–S30). Total shed blood volume was retransfused (541 ± 54.2 ml) over 30 min (T5–T30), after which a massive hemorrhage, 100 ml/min rate, was produced over 10 min (M5–M10).

Results

see figure 1

In general, TED overestimated PABF (r2 = 0.3472), but changes in TED paralleled PABF throughout the experimental protocol, principally during massive hemorrhage (r2 = 0.9001).

figure1

Figure 1

Conclusion

We conclude TED measures precisely cardiac output during massive hemorrhage. Probes designed for lower weights and smaller aortas may improve its accuracy in medium size animal models under less dramatic alterations induced by hemorrhage, shock and resuscitation.

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Poli de Figueiredo, L., Silva, E., Cruz, R. et al. Cardiac output determination during experimental hemorrhage and resuscitation using a transesophageal Doppler monitor. Crit Care 6, P192 (2002). https://doi.org/10.1186/cc1654

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Keywords

  • Cardiac Output
  • Mean Arterial Pressure
  • Pulmonary Artery Catheter
  • Massive Hemorrhage
  • Cardiac Output Measurement