title: Validity of an arterial pressure waveform analysis device: does the puncture site play a role in the agreement with intermittent pulmonary artery catheter thermodilution measurements?
abstract: OBJECTIVE
  The measurement of cardiac output is a key element in the assessment of cardiac function. Recently, a pulse contour analysis-based device without need for calibration became available (FloTrac/Vigileo, Edwards Lifescience, Irvine, CA). This study was conducted to determine if there is an impact of the arterial catheter site and to investigate the accuracy of this system when compared with the pulmonary artery catheter using the bolus thermodilution technique (PAC).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  The operating room of 1 university hospital.
  
  
  METHODS
  Twenty patients undergoing cardiac surgery.
  
  
  METHODS
  CO was determined in parallel by the use of the Flotrac/Vigileo systems in the radial and femoral position (CO_rad and CO_fem) and by PAC as the reference method. Data triplets were recorded at defined time points. The primary endpoint was the comparison of CO_rad and CO_fem, and the secondary endpoint was the comparison with the PAC.
  
  
  RESULTS
  Seventy-eight simultaneous data recordings were obtained. The Bland-Altman analysis for CO_fem and CO_rad showed a bias of 0.46 L/min, precision was 0.85 L/min, and the percentage error was 34%. The Bland-Altman analysis for CO_rad and PAC showed a bias of -0.35 L/min, the precision was 1.88 L/min, and the percentage error was 76%. The Bland-Altman analysis for CO_fem and PAC showed a bias of 0.11 L/min, the precision was 1.8 L/min, and the percentage error was 69%.
  
  
  CONCLUSIONS
  The FloTrac/Vigileo system was shown to not produce exactly the same CO data when used in radial and femoral arteries, even though the percentage error was close to the clinically acceptable range. Thus, the impact of the introduction site of the arterial catheter is not negligible. The agreement with thermodilution was low.
authors.affiliation: Department of Anesthesiology, University Hospital Lausanne, Lausanne, Switzerland. sebastian.schramm@chuv.ch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schramm
authors.forename: Eric
authors.initials: E
authors.lastname: Albrecht
authors.forename: Philippe
authors.initials: P
authors.lastname: Frascarolo
authors.forename: Pierre-Guy
authors.initials: PG
authors.lastname: Chassot
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology*; D011677:Punctures; D013815:Thermodilution / Q000295:instrumentation / Q000379:methods