title: Uncalibrated radial and femoral arterial pressure waveform analysis for continuous cardiac output measurement: an evaluation in cardiac surgery patients.
abstract: OBJECTIVE
  Arterial pressure waveform analysis is a less invasive alternative to the pulmonary artery catheter for continuous cardiac output (CO) measurement. Uncalibrated and calibrated systems are actually available (ie, the FloTrac/Vigileo system [Edwards Lifesciences, Irvine, CA] and the PiCCOplus system [Pulsion Medical Systems, Munich, Germany]). According to the FloTrac/Vigileo manufacturer, reliable measurements can be performed using any existing arterial catheter. The aim of this study was to evaluate CO determined by the FloTrac/Vigileo system using a radial (FCO(radial)) and femoral arterial catheter (FCO(femoral)) as well as the PiCCOplus system (PCO). Intermittent pulmonary artery thermodilution (ICO) was used as primary reference technique.
  
  
  METHODS
  A prospective clinical study.
  
  
  METHODS
  A teaching hospital, single center.
  
  
  METHODS
  Twenty-six cardiac surgery patients.
  
  
  METHODS
  Perioperative CO measurements.
  
  
  RESULTS
  CO was assessed at predefined measurement points. FCO(radial), FCO(femoral), and PCO were recorded after the induction of anesthesia, after sternotomy, at skin closure, after intensive care unit transfer, and during intensive care unit stay 12 and 24 hours after study initiation. ICO was determined as the mean of 3 bolus injections. Bland-Altman analysis revealed comparable mean bias and limits of agreement for FCO(radial), FCO(femoral), and PCO when compared with ICO. There was a decreased agreement for all devices in the postoperative period. However, a consistently close agreement was observed for the direct comparison between FCO(radial) and FCO(femoral).
  
  
  CONCLUSIONS
  Performance of the FloTrac/Vigileo system via radial as well as femoral access and the PiCCOplus monitoring for cardiac output measurement were comparable when tested against intermittent thermodilution in cardiac surgery patients.
authors.affiliation: Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland. christoph.hofer@triemli.stzh.ch
authors.forename: Christoph K
authors.initials: CK
authors.lastname: Hofer
authors.forename: Danny
authors.initials: D
authors.lastname: Button
authors.forename: Luc
authors.initials: L
authors.lastname: Weibel
authors.forename: Michele
authors.initials: M
authors.lastname: Genoni
authors.forename: Andreas
authors.initials: A
authors.lastname: Zollinger
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002138:Calibration / Q000592:standards; D002302:Cardiac Output / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000592:standards*; D002406:Catheterization, Peripheral / Q000379:methods / Q000592:standards; D005260:Female; D005263:Femoral Artery / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D017534:Radial Artery / Q000502:physiology*; D013815:Thermodilution / Q000379:methods / Q000592:standards