title: Comparison of uncalibrated arterial waveform analysis in cardiac surgery patients with thermodilution cardiac output measurements.
abstract: BACKGROUND
  Cardiac output (CO) monitoring is indicated only in selected patients. In cardiac surgical patients, perioperative haemodynamic management is often guided by CO measurement by pulmonary artery catheterisation (COPAC). Alternative strategies of CO determination have become increasingly accepted in clinical practice because the benefit of guiding therapy by data derived from the PAC remains to be proven and less invasive alternatives are available. Recently, a device offering uncalibrated CO measurement by arterial waveform analysis (COWave) was introduced. As far as this approach is concerned, however, the validity of the CO measurements obtained is utterly unclear. Therefore, the aim of this study was to compare the bias and the limits of agreement (LOAs) (two standard deviations) of COWave at four specified time points prior, during, and after coronary artery bypass graft (CABG) surgery with a simultaneous measurement of the gold standard COPAC and aortic transpulmonary thermodilution CO (COTranspulm).
  
  
  METHODS
  Data from 30 patients were analysed during this prospective study. COPAC, COTranspulm, and COWave were determined in all patients at four different time points prior, during, and after CABG surgery. The COPAC and the COTranspulm were measured by triple injection of 10 ml of iced isotone sodium chloride solution into the central venous line of the PAC. Measurements of COWave were simultaneously taken at these time points.
  
  
  RESULTS
  The overall correlation showed a Spearman correlation coefficient between COPAC and COWave of 0.53 (p < 0.01) and 0.84 (p < 0.01) for COPAC and COTranspulm. Bland-Altman analysis showed a mean bias and LOAs of 0.6 litres per minute and -2.2 to +3.4 litres per minute for COPAC versus COWave and -0.1 litres per minute and -1.8 to +1.6 litres per minute for COPAC versus COTranspulm.
  
  
  CONCLUSIONS
  Arterial waveform analysis with an uncalibrated algorithm COWave underestimated COPAC to a clinically relevant extent. The wide range of LOAs requires further evaluation. Better results might be achieved with an improved new algorithm. In contrast to this, we observed a better correlation of thermodilution COTranspulm and thermodilution COPAC measurements prior, during, and after CABG surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Charité Campus Mitte, Campus Virchow Klinikum, Charitéplatz 1, 10117 Berlin, Germany. michael.sander@charite.de
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
authors.forename: Herko
authors.initials: H
authors.lastname: Grubitzsch
authors.forename: Achim
authors.initials: A
authors.lastname: Foer
authors.forename: Marcus
authors.initials: M
authors.lastname: Müller
authors.forename: Christian
authors.initials: C
authors.lastname: von Heymann
mesh_terms: D000368:Aged; D001158:Arteries / Q000503:physiopathology*; D002138:Calibration; D002302:Cardiac Output; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D013815:Thermodilution
chemical_list: D007552:Isotonic Solutions; D012965:Sodium Chloride