A comparison of third-generation semi-invasive arterial waveform analysis with thermodilution in patients undergoing coronary surgery

Ole Broch, Jochen Renner, Matthias Gruenewald, Patrick Meybohm, Jan Schöttler, Markus Steinfath, Manu Malbrain, Berthold Bein, Ole Broch, Jochen Renner, Matthias Gruenewald, Patrick Meybohm, Jan Schöttler, Markus Steinfath, Manu Malbrain, Berthold Bein

Abstract

Uncalibrated semi-invasive continous monitoring of cardiac index (CI) has recently gained increasing interest. The aim of the present study was to compare the accuracy of CI determination based on arterial waveform analysis with transpulmonary thermodilution. Fifty patients scheduled for elective coronary surgery were studied after induction of anaesthesia and before and after cardiopulmonary bypass (CPB), respectively. Each patient was monitored with a central venous line, the PiCCO system, and the FloTrac/Vigileo-system. Measurements included CI derived by transpulmonary thermodilution and uncalibrated semi-invasive pulse contour analysis. Percentage changes of CI were calculated. There was a moderate, but significant correlation between pulse contour CI and thermodilution CI both before (r(2) = 0.72, P < 0.0001) and after (r(2) = 0.62, P < 0.0001) CPB, with a percentage error of 31% and 25%, respectively. Changes in pulse contour CI showed a significant correlation with changes in thermodilution CI both before (r(2) = 0.52, P < 0.0001) and after (r(2) = 0.67, P < 0.0001) CPB. Our findings demonstrated that uncalibrated semi-invasive monitoring system was able to reliably measure CI compared with transpulmonary thermodilution in patients undergoing elective coronary surgery. Furthermore, the semi-invasive monitoring device was able to track haemodynamic changes and trends.

Figures

Figure 1
Figure 1
Study design. T1: data collection (CIWave, CITPTD) after induction of anaesthesia and passive leg raising (PLR 1) until cardiopulmonary bypass; T2: data collection (CIWave, CITPTD) after cardiopulmonary bypass until the end of surgery and passive leg raising (PLR 2).
Figure 2
Figure 2
Correlation and Bland-Altman analysis of cardiac index measured by transpulmonary thermodilution (CITPTD) and cardiac index measured by uncalibrated semi-invasive pulse contour analysis (CIWave) before (T1) and after (T2) cardiopulmonary bypass.
Figure 3
Figure 3
Correlation and Bland-Altman analysis of percentage changes in cardiac index measured by transpulmonary thermodilution (ΔCITPTD) and cardiac index measured by uncalibrated semi-invasive pulse contour analysis (ΔCIWave) before and after cardiopulmonary bypass (CPB).

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