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Clinical validation of pulse contour and pulse wave transit time-based continuous cardiac output analyses in Thai
Insights
Arterial pressure-based cardiac output (APCO) and pulse wave transit time-based cardiac output (esCCO) monitors show acceptable trends compared to thermodilution cardiac output (TDCO) in Thai cardiac surgery patients. APCO demonstrated a lower mean bias than esCCO.
Area of Science:
- Cardiovascular Physiology
- Anesthesiology
- Surgical Monitoring
Background:
- Cardiac output (CO) monitoring is crucial during cardiopulmonary bypass.
- Non-invasive CO monitoring methods are increasingly important in clinical practice.
- Validation of advanced CO monitoring techniques in diverse patient populations is essential.
Purpose of the Study:
- To evaluate the performance of arterial pressure-based cardiac output (APCO) and pulse wave transit time-based cardiac output (esCCO) monitors.
- To compare APCO and esCCO against thermodilution cardiac output (TDCO) in Thai patients undergoing cardiac surgery.
- To assess the accuracy and reliability of these devices in a specific ethnic group.
Main Methods:
- Fifty Thai patients undergoing coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass were studied.
- APCO (Vigileo/FloTrac) and esCCO monitoring systems were used concurrently with standard pulmonary artery and radial artery catheters.
- Data were compared to thermodilution cardiac output (TDCO) using Bland-Altman analysis at multiple time points during surgery.
Main Results:
- Both APCO and esCCO showed significant correlations with TDCO (R = 0.53 and R = 0.56, respectively, p < 0.0001).
- Changes in APCO and esCCO also correlated significantly with changes in TDCO (R = 0.63 and R = 0.60, respectively, p < 0.0001).
- APCO exhibited a bias of 0.70 L/min with precision of +/- 1.63 L/min, while esCCO showed a bias of 1.20 L/min with precision of +/- 1.59 L/min.
Conclusions:
- APCO and esCCO, when calibrated with patient data, provide acceptable cardiac output trends compared to TDCO in Thai patients during CABG.
- APCO demonstrated a lower mean bias compared to esCCO, although precision was similar between the two methods.
- These findings suggest that APCO and esCCO can be valuable tools for monitoring cardiac output in this patient population, with APCO showing a slight advantage in bias reduction.
Objective:
To evaluate the performance of arterial pressure-based cardiac output (APCO) and pulse wave transit time-based cardiac output (esCCO) monitors in Thai patients undergoing cardiac surgery with cardiopulmonary bypass.
Material And Method:
The authors studied fifty Thai surgical patients undergoing coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass and requiring pulmonary artery catheters and radial artery catheter placement as a standard of clinical care. All patients were measured for APCO using the Vigileo/FloTrac and esCCO using the esCCO monitoring system. The data were compared to thermodilution cardiac output (TDCO) monitoring as a reference method, simultaneously at pre-induction of anesthesia, post-induction, and every 30 minutes thereafter until the completion of the surgery. The bias and precision were assessed using Bland-Altman analysis.
Results:
310 pairs of simultaneous measurements of APCO vs. TDCO and 303 pairs of esCCO vs. TDCO were obtained from fifty patients. Both APCO (R = 0.53, p < 0.0001) and esCCO values (R = 0.56, p < 0.0001) were correlated with TDCO values. Either of the changes in APCO (R = 0.63, p < 0.0001) or any changes in esCCO (R = 0.60, p < 0.0001) were correlated with changes in TDCO. For APCO relative to TDCO, the bias, precision, and the limits of agreement were 0.70, +/- 1.63, and -2.5 to 3.9 L/min while of esCCO were 1.20, +/-1.59 and -1.9 to 4.3 L/min, respectively. Comparisons of the bias of APCO and esCCO revealed a level of significance of p < 0.001.
Conclusion:
Despite the overestimation of CO measurements, APCO and esCCO calibrated with patient information has shown an acceptable trend as compared to TDCO in Thai patients undergoing CABG with cardiopulmonary bypass. Compared to esCCO, APCO demonstrated no significant differences ofprecision however; a lower mean bias was exhibited.
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