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October 25, 2015
1:00:00 PM - 3:00:00 PM
Room Hall B2-Area C
Accuracy and Precision of Minimally-invasive Cardiac Output Monitoring in Children: A Systematic Review and Meta-Analysis
Koichi Suehiro, M.D.,Ph.D., Alexandre P. Joosten, M.D., Linda Murphy, Not Applicable, Olivier Dessebe, M.D., Brenton Alexander, M.Sc., Maxime Cannesson, M.D.,Ph.D.
Osaka City University Graduate School of Medicine, Osaka City, Japan
Disclosures: K. Suehiro: None. A.P. Joosten: None. L. Murphy: None. O. Dessebe: None. B. Alexander: None. M. Cannesson: C. Royalties; Self; Sironis. D. Equity Position; Self; Edwards Lifesciences, Masimo, CHQI University of California, FAER, Nexefin, LIDCO, Deltex. F. Funded Research; Self; Edwards Lifesciences, Masimo Corp., Covidien. G. Consulting Fees; Self; IARS. H. Honoraria; Self; Orange.
[Background] Cardiac output (CO) monitoring is becoming essential in the pediatric intensive care and anesthesia settings. Several minimally-invasive and non-invasive technologies are available for CO measurement in children, but the accuracy and precision of these devices have not yet been evaluated in a systematic review and meta-analysis.

[Methods] We conducted a comprehensive search of the medical literature in PubMed, Cochrane Library of Clinical Trials, Scopus, and Web of Science from its inception to June 2014 assessing the accuracy and precision of all minimally-invasive CO monitoring systems used in children when compared with CO monitoring reference methods (dilution technique, Fick principle, transthoracic echocardiography, and transit time ultrasound measurement). Two reviewers separately assessed the quality of included studies using modified Quality Assessment of Diagnostic Accuracy Studies guidelines. Pooled mean bias, standard deviation (SD), and pooled percentage error (PE) of included studies were calculated using a random-effects model. The inter-study heterogeneity was also assessed using an I2 statistic.

[Results] A total of 20 studies (624 patients) were included. The overall random-effects pooled bias, and PE were 0.13 ± 0.44 L/min (95% LOA: -0.74 to 0.99 L/min) and 29.1%, respectively (Figure 1). Significant inter-study heterogeneity was detected for both bias (P <0.0001, I2=98.3%) and SD (P <0.0001, I2=99.9%). In the sub-analysis regarding the device, electrical cardiometry showed the smallest bias (-0.03 L/min) and lowest PE (23.6%) (Figure 2). Significant residual heterogeneity remained after conducting sensitivity and subgroup analyses based on the various study characteristics. By meta-regression analysis, we found no independent effects of study characteristics on weighted mean difference between reference and tested methods.

[Conclusions] Although the pooled bias was small, the pooled PE was in the gray zone of clinical applicability (around the acceptable limit of 30%). In the sub-group analysis, electrical cardiometry was the device that provided the most accurate measurement. However, a high heterogeneity between studies was found, likely due to a wide range of study characteristics. At this time, physicians should be careful when making clinical decisions regarding hemodynamic interventions using minimally-invasive CO monitoring in children.
Figure 1
Figure 2

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