Clin Surg | Volume 6, Issue 1 | Research Article | Open Access

Accuracy, Precision and Trending Ability of Electrical Cardiometry vs. Esophageal Doppler in Major Abdominal Surgery: A Prospective, Observational Study

P Boris W Cox1*, Jack WAM Oomen2, Maurice Theunissen1, Leon J Montenij3, Marcus D Lancé4 and Wolfgang FFA Buhre1

1Department of Anesthesiology and Pain Management, Maastricht University Medical Centre+, The Netherlands
2Department of Anesthesiology, ETZ Elisabeth Hospital, The Netherlands
3Department of Anesthesiology, Catharina Ziekenhuis, The Netherlands
4Department of Anesthesiology, ICU and Perioperative Medicine, HMC, Qatar

*Correspondance to: P Boris W Cox 

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Background: This study was performed to evaluate the accuracy, precision and trending ability of Cardiac Output (CO) measurements using the Aesculon™ bioimpedance electrical cardiometry (Aesc) compared to the CardioQ™ (CardioQ) esophageal Doppler technique at different time points during the perioperative period in major abdominal surgery. Methods: We performed a prospective observational study in 50 patients, physical status ASA 1-4, referred for major abdominal surgery. After induction of anesthesia the Esophageal Doppler probe was placed and the bioimpedance device was connected. At eight time points (T) before, during and after surgery measurements of Cardiac Index (CI), and standard hemodynamics were performed. CI was measured simultaneously by thoracic bioimpedance and esophageal Doppler. The primary objective was to assess agreement of the thoracic bioimpedance method compared to the transesophageal Doppler method for Cardiac Index (CI) and the secondary objective was to determine if the surgical incision would have effect on bioimpedance measurements. Main analysis was performed using Bland Altman analysis, polar plot methodology, and four-quadrant plot. Results: Data of all 50 patients were suitable for analysis. CI obtained with the CardioQ™ and Aesculon™ ranged from 1.2 to 7.6 L min-1 and 0.8 and 5.6 L min-1 respectively. Bland-Altman analysis showed a bias between CIbio and CIcardioQ of - 1.0 liter min-1 m-2, with LOA of [-3.02 to 0.89] liter min-1 m-2. The percentage error between the two techniques was greater than 30% at every time point. Polar plot methodology and 4-quadrant analysis showed poor trending ability. Skin incision during surgery had no effect on the difference between the two measurement techniques. Conclusion: Esophageal Doppler and bioimpedance technology for CO/CI measurements are not interchangeable in patients undergoing major abdominal surgery. The surgical incision has no effects on bioimpedance measurements.


Cardiac output; Electrical impedance; Electrical cardiometry; Esophageal Doppler monitor; Accuracy; Precision


Cox PBW, Oomen JWAM, Theunissen M, Montenij LJ, Lancé MD, Buhre WFFA. Accuracy, Precision and Trending Ability of Electrical Cardiometry vs. Esophageal Doppler in Major Abdominal Surgery: A Prospective, Observational Study. Clin Surg. 2021; 6: 3267..

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