title: Continuous cardiac output monitoring with an uncalibrated pulse contour method in patients supported with mechanical pulsatile assist device.
abstract: We evaluated the accuracy of an uncalibrated pulse contour method called Pressure Recording Analytical Method (PRAM) compared with continuous thermodilution for cardiac output (CO) monitoring in patients implanted with a pulsatile left ventricular assist device (LVAD). Twelve adult patients implanted with the HeartMate I-XVE device were studied. CO was simultaneously evaluated by PRAM and by continuous thermodilution. Blood flow values displayed by the LVAD's console were also used for the comparison. Bland-Altman and linear regression analyses were applied. A total of 72 CO measurements (range 3.8-6.7 l/min) were obtained. Mean CO was 5.23±0.70 l/min for the 'hot' pulmonary thermodilution (ThD-CCO) method, 5.28±0.63 l/min for PRAM and 4.83±0.67 l/min for LVAD-CO. A high correlation (r=0.90), a good agreement (mean bias -0.04 l/min, precision ±0.38 l/min) and a low percentage of error (7.3%) were observed between PRAM-CO and ThD-CCO. A good correlation was found between LVAD-CO and either ThD-CCO (r=0.88) or PRAM-CO (r=0.86), but an overestimation of 10% was observed for both PRAM-CO (mean bias -0.44 l/min) and ThD-CCO (mean bias -0.40 l/min). Our results demonstrated good agreements between PRAM-CO, ThD-CCO and LVAD-CO. PRAM derives CO from a peripheral artery without calibration and may be a complementary tool in the hemodynamic assessment of patients supported with a VAD.
authors: Department of Surgery and Bioengineering, University of Siena, Siena, Italy.
authors: Sabino
authors: S
authors: Scolletta
authors: Fabio
authors: F
authors: Miraldi
authors: Salvatore Mario
authors: SM
authors: Romano
authors: Luigi
authors: L
authors: Muzzi
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation; D015924:Blood Pressure Monitors; D002302:Cardiac Output; D002406:Catheterization, Peripheral; D002407:Catheterization, Swan-Ganz; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000503:physiopathology; D017534:Radial Artery / Q000503:physiopathology; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D013815:Thermodilution; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left