Measurement of cardiac output by transesophageal Doppler ultrasonography in anesthetized dogs: comparison with thermodilution

Thermodilution (TD) is the standard method for cardiac output (CO) monitoring in human medicine. Although called the ‘gold standard’, TD is related to numerous complications and data misinterpretations. Recently, a noninvasive, continuous, ultrasound‐based technique for CO measurement has been developed (Hemosonic 100, Arrow Intl). This study compared transesophageal Doppler ultrasonography (TED) for measuring CO with TD in anesthetized dogs. In this study, ten dogs were used to simultaneously measure CO by TED and TD. All dogs were pre‐medicated with acepromazine at 0.1 mg kg^?1 IM, induced with thiopental at 10 mg kg^?1 IV, and maintained on isoflurane at end‐tidal concentrations of 1.3%. Baseline and four different levels of CO were used for comparison. Low CO levels were induced by caudal vena cava occlusion. High CO levels were induced by the constant IV infusion of dopamine, dobutamine, or norepinephrine. Each level of CO allowed one comparison between TED and TD. Forty‐nine paired comparisons of CO were determined ranging from 0.73 to 10.9 L minute^?1. Simple linear regression was used to determine the correlation between the two techniques. Correlation coefficient (r²) was 0.53. Bland and Altman statistical method was used for assessing agreement between the two methods. The difference between the TD and TED when all data were included was 0.82 (bias) ± 1.63 L minute^?1 (mean ± SD). At low CO levels (baseline and caudal vena cava occlusion), the correlation coefficient was 0.77, bias was 0.35 ± 0.64 L minute^?1. At high CO levels (dopamine, dobutamine, or norepinephrine), the correlation coefficient was 0.39. It was concluded that TED was not a reliable monitoring method in determining CO when positive inotropes were used. TED might have importance in situations of low CO values; however, further investigation is warranted.