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Pulse Wave Analysis Using the Pressure Recording Analytical Method to Measure Cardiac Output in Pediatric Cardiac
Gillis Greiwe1, Vanessa Balfanz1, Alexander Hapfelmeier2,3
1From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
The Pressure Recording Analytical Method (PRAM) accurately measures cardiac output in pediatric patients undergoing surgery. This invasive pulse wave analysis method shows clinically acceptable agreement with transesophageal Doppler echocardiography.
Area of Science:
- Cardiology
- Pediatric Anesthesiology
- Medical Devices
Background:
- Cardiac output (CO) is crucial for oxygen delivery, but its measurement in pediatric patients is challenging.
- The Pressure Recording Analytical Method (PRAM) is an invasive, uncalibrated pulse wave analysis (PWA) technique for CO monitoring.
- Optimal CO measurement methods in pediatric populations require further investigation.
Purpose of the Study:
- To compare cardiac output measured by PRAM (PRAM-CO) against transesophageal Doppler echocardiography (TEE-CO) in pediatric patients.
- To evaluate the clinical agreement between PRAM-CO and TEE-CO in a pediatric cardiac surgery setting.
Main Methods:
- A prospective observational study comparing PRAM-CO and TEE-CO in pediatric elective cardiac surgery patients.
- Measurements were taken at two time points: post-anesthesia induction and post-surgery.
- Bland-Altman analysis and percentage error (PE) were used to assess agreement between the two methods.
Main Results:
- Data from 30 patients (52 measurement pairs) were analyzed.
- Mean TEE-CO was 2.15 ± 1.31 L/min, and mean PRAM-CO was 2.21 ± 1.38 L/min.
- The percentage error (PE) between PRAM-CO and TEE-CO was 34% (95% CI, 27%-41%), indicating acceptable agreement.
Conclusions:
- PRAM-CO demonstrates clinically acceptable agreement with TEE-CO in hemodynamically stable pediatric patients.
- A PE of <45% supports the use of PRAM-CO as a viable method for CO monitoring in this population.
- The findings suggest PRAM is a reliable tool for cardiac output assessment in pediatric cardiac surgery.
Background:
Cardiac output (CO) is a key determinant of oxygen delivery, but choosing the optimal method to obtain CO in pediatric patients remains challenging. The pressure recording analytical method (PRAM), implemented in the MostCareUp system (Vygon), is an invasive uncalibrated pulse wave analysis (PWA) method to measure CO. The objective of this study is to compare CO measured by PRAM (PRAM-CO; test method) with CO simultaneously measured by transesophageal Doppler echocardiography (TEE-CO; reference method) in pediatric patients.
Methods:
In this prospective observational method comparison study, PRAM-CO and TEE-CO were assessed in pediatric elective cardiac surgery patients at 2 time points: after anesthesia induction and after surgery. The study was performed in a German university medical center from March 2019 to March 2020. We included pediatric patients scheduled for elective cardiac surgery with arterial catheter and TEE monitoring. PRAM-CO and TEE-CO were compared using Bland-Altman analysis accounting for repeated measurements per subject, and the percentage error (PE).
Results:
We included 52 PRAM-CO and TEE-CO measurement pairs of 30 patients in the final analysis. Mean ± SD TEE-CO was 2.15 ± 1.31 L/min (range 0.55-6.07 L/min), and mean PRAM-CO was 2.21 ± 1.38 L/min (range 0.55-5.90 L/min). The mean of the differences between TEE-CO and PRAM-CO was -0.06 ±0.38 L/min with 95% limits of agreement (LOA) of 0.69 (95% confidence interval [CI], 0.53-0.82 L/min) to -0.80 L/min (95% CI, -1.00 to -0.57 L/min). The resulting PE was 34% (95% CI, 27%-41%).
Conclusions:
With a PE of <45%, PRAM-CO shows clinically acceptable agreement with TEE-CO in hemodynamically stable pediatric patients before and after cardiac surgery.
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