Simultaneous Evaluation of Pulse Contour Devices Using an Innovative Hemodynamic Simulation Bench.

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Biomedical Engineering

Background:

• Continuous cardiac output (CO) monitoring is vital for critically ill patients.
• Several arterial pulse contour devices have emerged, necessitating comparative accuracy assessments.
• No prior experimental studies have evaluated these devices in a controlled setting.

Purpose of the Study:

• To experimentally compare the accuracy of three arterial pulse contour devices: FloTrac™, proAQT™, and LiDCO™ Plus.
• To evaluate device performance under various controlled hemodynamic challenges (HCs) using a novel simulation bench.

Main Methods:

• Utilized a Donovan mock circulatory system with a total artificial heart (TAH-t) to generate stable arterial waveforms.
• Simultaneously assessed CO estimates from FloTrac™, proAQT™, and LiDCO™ Plus during simulated decreased preload, increased heart rate, and decreased afterload.
• Employed Bland-Altman analysis for agreement assessment, alongside error percentage and variation coefficient calculations.

Main Results:

• No significant differences were found between simultaneously generated arterial waveforms.
• Cardiac output (CO) estimates varied significantly across devices and HCs, with notable decreases during decreased preload and increases during decreased afterload.
• Bland-Altman analysis indicated varying degrees of agreement between the tested pulse contour devices.

Conclusions:

• The Donovan Mock Circulatory System with SynCardia TAH-t provides a stable, accurate, and reliable platform for evaluating pulse contour devices.
• This experimental setup allows for realistic, controlled comparisons of device performance and limitations under diverse hemodynamic conditions.
• Findings are crucial for clinicians to understand and select appropriate CO monitoring devices based on performance characteristics.