Cardiac output estimation by pulse wave analysis using the pressure recording analytical method and intermittent pulmonary artery thermodilution: A method comparison study in patients after off-pump coronary artery bypass surgery

TY - JOUR

T1 - Cardiac output estimation by pulse wave analysis using the pressure recording analytical method and intermittent pulmonary artery thermodilution: A method comparison study in patients after off-pump coronary artery bypass surgery

AU - Greiwe, Gillis

AU - Luehsen, Katharina

AU - Hapfelmeier, Alexander

AU - Rogge, Dorothea

AU - Kubik, Mathias

AU - Schulte-Uentrop, Leonie

AU - Saugel, Bernd

PY - 2020/10

Y1 - 2020/10

N2 - BACKGROUND: Invasive pulse wave analysis is used in peri-operative settings to estimate cardiac output (CO). The 'pressure recording analytical method' (PRAM) implemented in the MostCareUp CO monitor is an invasive pulse wave analysis method using high-frequency sampling and analysis of the pulse wave to directly estimate the arterial impedance as a key variable of the proprietary CO estimation algorithm.OBJECTIVE: To compare CO estimated by PRAM (PRAM-CO; test method) with CO measured by pulmonary artery thermodilution (PATD-CO; reference method).DESIGN: Prospective observational method comparison study. PRAM-CO and PATD-CO were assessed simultaneously at five time points with at least 20 min between measurements. Arterial pressure waveforms were carefully checked for damping artefacts and a proprietary electronic filter of the MostCareUp CO monitor was used to optimise waveform quality.SETTING: ICU of a German university hospital from August 2018 until April 2019.PATIENTS: We included adult patients admitted to the ICU after elective off-pump coronary artery bypass surgery who were monitored with a radial arterial catheter and a pulmonary artery catheter. Patients with severe heart valve insufficiency or persistent arrhythmia were excluded.MAIN OUTCOME MEASURES AND ANALYSIS: PATD-CO and PRAM-CO were compared using Bland-Altman analysis accounting for repeated measurements, the percentage error and trending analysis (four-quadrant plot, concordance rate).RESULTS: We analysed 195 paired CO values of 41 patients. Mean PATD-CO and PRAM-CO were 4.99 ± 1.02 and 4.92 ± 1.05 l min, respectively. PATD-CO and PRAM-CO ranged from 3.04 to 8.74 and 2.79 to 8.01 l min, respectively. The mean of the differences between PATD-CO and PRAM-CO was -0.08 ± 0.74 l min with 95% limits of agreement of -1.55 to +1.40 l min. The percentage error was 29.8%. The concordance rate in four-quadrant plot analysis was 92%.CONCLUSION: Using the system's electronic waveform filter PRAM-CO shows good agreement and trending ability compared with PATD-CO in adults after off-pump coronary artery bypass surgery.

AB - BACKGROUND: Invasive pulse wave analysis is used in peri-operative settings to estimate cardiac output (CO). The 'pressure recording analytical method' (PRAM) implemented in the MostCareUp CO monitor is an invasive pulse wave analysis method using high-frequency sampling and analysis of the pulse wave to directly estimate the arterial impedance as a key variable of the proprietary CO estimation algorithm.OBJECTIVE: To compare CO estimated by PRAM (PRAM-CO; test method) with CO measured by pulmonary artery thermodilution (PATD-CO; reference method).DESIGN: Prospective observational method comparison study. PRAM-CO and PATD-CO were assessed simultaneously at five time points with at least 20 min between measurements. Arterial pressure waveforms were carefully checked for damping artefacts and a proprietary electronic filter of the MostCareUp CO monitor was used to optimise waveform quality.SETTING: ICU of a German university hospital from August 2018 until April 2019.PATIENTS: We included adult patients admitted to the ICU after elective off-pump coronary artery bypass surgery who were monitored with a radial arterial catheter and a pulmonary artery catheter. Patients with severe heart valve insufficiency or persistent arrhythmia were excluded.MAIN OUTCOME MEASURES AND ANALYSIS: PATD-CO and PRAM-CO were compared using Bland-Altman analysis accounting for repeated measurements, the percentage error and trending analysis (four-quadrant plot, concordance rate).RESULTS: We analysed 195 paired CO values of 41 patients. Mean PATD-CO and PRAM-CO were 4.99 ± 1.02 and 4.92 ± 1.05 l min, respectively. PATD-CO and PRAM-CO ranged from 3.04 to 8.74 and 2.79 to 8.01 l min, respectively. The mean of the differences between PATD-CO and PRAM-CO was -0.08 ± 0.74 l min with 95% limits of agreement of -1.55 to +1.40 l min. The percentage error was 29.8%. The concordance rate in four-quadrant plot analysis was 92%.CONCLUSION: Using the system's electronic waveform filter PRAM-CO shows good agreement and trending ability compared with PATD-CO in adults after off-pump coronary artery bypass surgery.

U2 - 10.1097/EJA.0000000000001227

DO - 10.1097/EJA.0000000000001227

M3 - SCORING: Journal article

C2 - 32398582

VL - 37

SP - 920

EP - 925

JO - EUR J ANAESTH

JF - EUR J ANAESTH

SN - 0265-0215

IS - 10

ER -