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Accuracy of cardiac output measurements with pulse contour analysis (PulseCO™) and Doppler echocardiography during off-pump coronary artery bypass grafting

Published online by Cambridge University Press:  01 March 2008

C. Missant ,
S. Rex  and
P. F. Wouters
C. Missant*
Affiliation:
Katholieke Universiteit Leuven, University Hospitals, Department of Acute Medical Sciences – Anaesthesiology, U. Z. Gasthuisberg, Leuven, Belgium
S. Rex
Affiliation:
Katholieke Universiteit Leuven, University Hospitals, Department of Acute Medical Sciences – Anaesthesiology, U. Z. Gasthuisberg, Leuven, Belgium University Hospital of the RWTH Aachen, Department of Anaesthesiology, Germany
P. F. Wouters*
Affiliation:
University Hospitals Ghent, Department of Anesthesiology, Ghent, Belgium
*
Correspondence to: Patrick F. Wouters, Department of Anesthesiology, University Hospitals Ghent, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail: patrick.wouters@ugent.be; Tel: +32 9 332 3281; Fax: +32 9 332 4987
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Summary

Background and objective

During off-pump coronary bypass grafting, surgical manipulation and dislocation of the heart may cause cardiovascular instability. Monitoring of cardiac output facilitates intraoperative haemodynamic management but pulmonary artery catheters are often considered too invasive. Pulse contour analysis and transoesophageal echocardiography could serve as alternatives, but there is controversy about their accuracies. We validated pulse contour analysis using a standard radial arterial catheter (PulseCO™) and aortic Doppler flowmetry with transoesophageal echocardiography in patients undergoing off-pump coronary bypass surgery. Pulmonary arterial thermodilution served as the reference technique.

Methods

In 20 patients undergoing off-pump coronary bypass, cardiac output was measured with bolus thermodilution (COTD), pulse contour analysis (COPC), and transoesophageal echocardiography (COecho) at fixed time intervals during the procedure. Data were compared using linear regression and Bland–Altman analysis. At the end of the procedure, dobutamine was infused at a rate of 2.5 μg kg−1 min−1 in six patients to study the agreement between methods in quantifying changes in cardiac output.

Results

Comparison between COPC and COTD showed a bias ± limits of agreement of −0.03 ± 1.30 L min−1 (mean error 29%). Doppler echocardiography was not always feasible when the heart was displaced from the oesophagus and had lower accuracy: bias ± limits of agreement vs. COTD was 0.45 ± 1.93 (mean error 43%). Increases in cardiac output induced by dobutamine were well quantified both by pulse contour analysis (COPC = 0.76 × COTD + 0.58; r2 = 0.65) and Doppler, although the latter tended to overestimate these changes (COecho = 1.58 × COTD − 0.13; r2 = 0.53).

Conclusions

Calibrated pulse contour analysis using the PulseCO system is an acceptable technique to measure cardiac output non-invasively in off-pump coronary bypass patients. Doppler echocardiography performs less well and is not always feasible with transoesophageal echocardiography when the heart is displaced.

Keywords

SURGERY CARDIACCORONARY ARTERY BYPASS GRAFTINGCORONARY ARTERY BYPASS OFF-PUMPCARDIAC OUTPUTPHYSIOLOGIC MONITORING
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 3 , March 2008 , pp. 243 - 248
Copyright
Copyright © European Society of Anaesthesiology 2008

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