Accuracy of an autocalibrated pulse contour analysis in cardiac surgery patients: a bi-center clinical trial

Ole Broch, Jose Carbonell, Carlos Ferrando, Malte Metzner, Arne Carstens, Martin Albrecht, Matthias Gruenewald, Jan Höcker, Marina Soro, Markus Steinfath, Jochen Renner, Berthold Bein, Ole Broch, Jose Carbonell, Carlos Ferrando, Malte Metzner, Arne Carstens, Martin Albrecht, Matthias Gruenewald, Jan Höcker, Marina Soro, Markus Steinfath, Jochen Renner, Berthold Bein

Abstract

Background: Less-invasive and easy to install monitoring systems for continuous estimation of cardiac index (CI) have gained increasing interest, especially in cardiac surgery patients who often exhibit abrupt haemodynamic changes. The aim of the present study was to compare the accuracy of CI by a new semi-invasive monitoring system with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB).

Methods: Sixty-five patients (41 Germany, 24 Spain) scheduled for elective coronary surgery were studied before and after CPB, respectively. Measurements included CI obtained by transpulmonary thermodilution (CITPTD) and autocalibrated semi-invasive pulse contour analysis (CIPFX). Percentage changes of CI were also calculated.

Results: There was only a poor correlation between CITPTD and CIPFX both before (r (2) = 0.34, p < 0.0001) and after (r (2) = 0.31, p < 0.0001) CPB, with a percentage error (PE) of 62 and 49 %, respectively. Four quadrant plots revealed a concordance rate over 90 % indicating an acceptable correlation of trends between CITPTD and CIPFX before (concordance: 93 %) and after (concordance: 94 %) CPB. In contrast, polar plot analysis showed poor trending before and an acceptable trending ability of changes in CI after CPB.

Conclusions: Semi-invasive CI by autocalibrated pulse contour analysis showed a poor ability to estimate CI compared with transpulmonary thermodilution. Furthermore, the new semi-invasive device revealed an acceptable trending ability for haemodynamic changes only after CPB.

Trial registration: ClinicalTrials.gov: NCT02312505 Date: 12.03.2012.

Figures

Fig. 1
Fig. 1
Study design with data collection starting after induction of anaesthesia and PLR until CPB (T1) and data collection restarting after CPB until the end of surgical intervention (T2); CITPTD, cardiac index by transpulmonary thermodilution; CIPFX, cardiac index by semi-invasive pulse contour analysis; PLR, passive leg raising; CPB, cardiopulmonary bypass.
Fig. 2
Fig. 2
Before (pre) and after (post) cardiopulmonary bypass (CPB): a, b Correlation of cardiac index estimated by transpulmonary thermodilution (CITPTD) and cardiac index estimated by semi-invasive autocalibrated pulse contour analysis (CIPFX); c, d Bland-Altman analysis showing the agreement between cardiac index estimated by transpulmonary thermodilution (CITPTD) and cardiac index estimated by semi-invasive autocalibrated pulse contour analysis (CIPFX).
Fig. 3
Fig. 3
Exponential function of correlation between cardiac index measured by autocalibrated semi-invasive pulse contour analysis (CIPFX) and systemic vascular resistance index (SVRI) estimated by transpulmonary thermodilution (SVRITPTD) and by pulse contour analysis (SVRIPFX) before (pre) and after (post) cardiopulmonary bypass (CPB)
Fig. 4
Fig. 4
a, b Four quadrant concordance plots of changes of cardiac index measured by transpulmonary thermodilution (CITPTD) and cardiac index estimated by autocalibrated semi-invasive pulse contour analysis (CIPFX) before and after cardiopulmonary bypass (CPB). Changes below 15 % (gray rectangle) were excluded from correlation analysis. c, d Polar plot analysis on trending ability of changes in cardiac index (∆CI) before and after cardiopulmonary bypass (CPB). The solid line included data pairs within the 10 % limits of agreement (± 0.30 L/min/m2 before and ± 0.35 L/min/m2 after CPB) and indicated good trending. Data pairs within the 20 % limits of agreement (±0.6 L/min/m2 before and ± 0.7 L/min/m2 after CPB, dotted line) indicated acceptable trending ability. The mean CI was 3.0 L/min/m2 before and 3.5 L/min/m2 after CPB. Exclusion zone was determined <0.2 L/min/m2.

References

    1. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392–1402. doi: 10.1213/ANE.0b013e3181eeaae5.
    1. Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354:2213–2224. doi: 10.1056/NEJMoa061895.
    1. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5–14.4. doi: 10.1056/NEJMoa021108.
    1. Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2003;290:2713–2720. doi: 10.1001/jama.290.20.2713.
    1. Sander M, Spies CD, Grubitzsch H, Foer A, Muller M, von Heymann C. Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements. Crit Care. 2006;10:R164. doi: 10.1186/cc5103.
    1. Friesecke S, Heinrich A, Abel P, Felix SB. Comparison of pulmonary artery and aortic transpulmonary thermodilution for monitoring of cardiac output in patients with severe heart failure: validation of a novel method. Crit Care Med. 2009;37:119–123. doi: 10.1097/CCM.0b013e31819290d5.
    1. Ritter S, Rudiger A, Maggiorini M. Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study. Crit Care. 2009;13:R133. doi: 10.1186/cc7994.
    1. Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. Thorac Cardiovasc Surg. 1998;46:242–249.
    1. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15:85–91. doi: 10.1023/A:1009982611386.
    1. Schloglhofer T, Gilly H, Schima H. Semi-invasive measurement of cardiac output based on pulse contour: a review and analysis. Can J Anaesth. 2014;61:452–479.11. doi: 10.1007/s12630-014-0135-8.
    1. Critchley LA, Lee A, Ho AM. A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg. 2010;111:1180–1192. doi: 10.1213/ANE.0b013e3181f08a5b.
    1. McGuinness S, Parke R. Using cardiac output monitoring to guide perioperative haemodynamic therapy. Curr Opin Crit Care. 2015;21:364–368. doi: 10.1097/MCC.0000000000000212.
    1. Sagawa K, Lie RK, Schaefer J. Translation of Otto Frank's paper "Die Grundform des Arteriellen Pulses" Zeitschrift fur Biologie 37: 483–526 (1899) J Mol Cell Cardiol. 1990;22:253–277. doi: 10.1016/0022-2828(90)91459-K.
    1. Suehiro K, Tanaka K, Funao T, Matsuura T, Mori T, Nishikawa K. Systemic vascular resistance has an impact on the reliability of the Vigileo-FloTrac system in measuring cardiac output and tracking cardiac output changes. Br J Anaesth. 2013;111:170–177. doi: 10.1093/bja/aet022.
    1. Monnet X, Anguel N, Naudin B, Jabot J, Richard C, Teboul JL. Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices. Crit Care. 2010;14:R109. doi: 10.1186/cc9058.
    1. Smetkin AA, Hussain A, Kuzkov VV, Bjertnaes LJ, Kirov MY. Validation of cardiac output monitoring based on uncalibrated pulse contour analysis vs transpulmonary thermodilution during off-pump coronary artery bypass grafting. Br J Anaesth. 2014;112:1024–1031. doi: 10.1093/bja/aet489.
    1. Godje O, Hoke K, Lamm P, Schmitz C, Thiel C, Weinert M, et al. Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery. Thorac Cardiovasc Surg. 1998;46:242–249. doi: 10.1055/s-2007-1010233.
    1. Godje O, Hoke K, Goetz AE, Felbinger TW, Reuter DA, Reichart B, et al. Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med. 2002;30:52–58. doi: 10.1097/00003246-200201000-00008.
    1. Langewouters GJ, Zwart A, Busse R, Wesseling KH. Pressure-diameter relationships of segments of human finger arteries. Clin Phys Physiol Meas. 1986;7:43–56. doi: 10.1088/0143-0815/7/1/003.
    1. Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY. Does radial artery pressure accurately reflect aortic pressure? Chest. 1992;102:1193–1198. doi: 10.1378/chest.102.4.1193.
    1. Monnet X, Vaquer S, Anguel N, Jozwiak M, Cipriani F, Richard C, et al. Comparison of pulse contour analysis by Pulsioflex and Vigileo to measure and track changes of cardiac output in critically ill patients. Br J Anaesth. 2015;114:235–243. doi: 10.1093/bja/aeu375.
    1. Schramm S, Albrecht E, Frascarolo P, Chassot PG, Spahn DR. Validity of an Arterial Pressure Waveform Analysis Device: Does the Puncture Site Play a Role in the Agreement With Intermittent Pulmonary Catheter Thermodilution Measurements? J Cardiothorac Vasc Anesth. 2009;24:250–6. doi: 10.1053/j.jvca.2009.05.029.
    1. Junttila EK, Koskenkari JK, Ohtonen PP, Ala-Kokko TI. Uncalibrated arterial pressure waveform analysis for cardiac output monitoring is biased by low peripheral resistance in patients with intracranial haemorrhage. Br J Anaesth. 2011;107:581–586. doi: 10.1093/bja/aer170.
    1. Yamashita K, Nishiyama T, Yokoyama T, Abe H, Manabe M. The effects of vasodilation on cardiac output measured by PiCCO. J Cardiothorac Vasc Anesth. 2008;22:688–692. doi: 10.1053/j.jvca.2008.04.007.
    1. Squara P, Cecconi M, Rhodes A, Singer M, Chiche JD. Tracking changes in cardiac output: methodological considerations for the validation of monitoring devices. Intensive Care Med. 2009;35:1801–1808. doi: 10.1007/s00134-009-1570-9.
    1. Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies--with specific reference to the measurement of cardiac output. Crit Care. 2009;13:201. doi: 10.1186/cc7129.
    1. De Backer D, Marx G, Tan A, Junker C, Van Nuffelen M, Huter L, et al. Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med. 2011;37:233–240. doi: 10.1007/s00134-010-2098-8.
    1. Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth. 2011;25:536–546. doi: 10.1053/j.jvca.2011.01.003.
    1. Salzwedel C, Puig J, Carstens A, Bein B, Molnar Z, Kiss K, et al. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care. 2013;17:R191. doi: 10.1186/cc12885.
    1. Sander M, von Heymann C, Foer A, von Dossow V, Grosse J, Dushe S, et al. Pulse contour analysis after normothermic cardiopulmonary bypass in cardiac surgery patients. Crit Care. 2005;9:R729–734. doi: 10.1186/cc3903.
    1. Hofkens PJ, Verrijcken A, Merveille K, Neirynck S, Van Regenmortel N, De Laet I, et al. Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review. Anaesthesiol Intensive Ther. 2015;47:89–116. doi: 10.5603/AIT.a2014.0068.
    1. Denault A, Deschamps A. Abnormal aortic-to-radial arterial pressure gradients resulting in misdiagnosis of hemodynamic instability. Can J Anaesth. 2009;56:534–536. doi: 10.1007/s12630-009-9088-8.

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