Continuous versus intermittent cardiac output measurement in cardiac surgical patients undergoing hypothermic cardiopulmonary bypass.
OBJECTIVE
Continuous thermodilution cardiac output (CCO) measurement was clinically evaluated in patients who underwent coronary revascularization using hypothermic low-flow, low-pressure cardiopulmonary bypass (CPB).


METHODS
Prospective study.


METHODS
University hospital setting.


METHODS
30 cardiac surgical patients.


METHODS
CCO was correlated to standard bolus thermodilution cardiac output (ICO) obtained at end-expiration.


RESULTS
Measurements were taken at selected time points (n = 18) before anesthesia induction, before CPB, and 5 minutes to 12 hours after CPB. A total of 540 data pairs were thus obtained. ICO ranged from 1.9 to 9.9 L/min, CCO from 1.5 to 9.9 L/min. Correlation between ICO and CCO was highly significant (r = 0.872; p < 0.01), accompanied by an excellent accuracy (bias -0.0213 L) and precision (0.59 L) before CPB and more than 45 minutes after CPB. However, during the first 45 minutes after CPB, there was no correlation (r = 0.273) between ICO and CCO, and ICO tended to be relatively high, whereas CCO measurements showed relatively low values. During the first 45 minutes after hypothermic CPB, but not during the ensuing time period, central blood temperature decreased, which may be interpreted as a lack of thermal equilibration between central and peripheral compartments. It is hypothesized that thermal instability in combination with increased respiratory variations in pulmonary artery blood temperature caused inhomogenous rewarming of different body sites and might be the main reason for the lack of correlation between ICO and CCO.


CONCLUSIONS
Despite an excellent correlation, accuracy, and precision between CCO and ICO before CPB and more than 45 minutes after hypothermic CPB, a lack of correlation in the early phase after CPB has been found. Further investigation is needed to elucidate the underlying cause of these findings and to clarify whether ICO or CCO or both fail to represent the real cardiac output up to 45 minutes after weaning from hypothermic CPB.
Böttiger
B W
BW
Department of Anesthesiology, University of Heidelberg, Germany.
Rauch
H
H
Böhrer
H
H
Motsch
J
J
Soder
M
M
Fleischer
F
F
Martin
E
E
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D015982:Bias; D001769:Blood; D001831:Body Temperature; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002405:Catheterization, Central Venous / Q000295:instrumentation; D003626:Data Display; D006801:Humans; D007036:Hypothermia, Induced; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009204:Myocardial Revascularization; D011446:Prospective Studies; D012119:Respiration; D017694:Rewarming; D012680:Sensitivity and Specificity; D013815:Thermodilution / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors