Cardiac Output Assessed by the Fourth-Generation Arterial Waveform Analysis System Is Unreliable in Liver Transplant Recipients.
BACKGROUND
Liver transplant recipients often have violent hemodynamic fluctuation during surgery that may be related to perioperative and postoperative morbidity. Because there are some considerations for the risk of the pulmonary arterial catheter (PAC), the conventional invasive device for cardiac output (CO) measurement, a reliable and minimally invasive alternative is required. We validated the reliability of CO measurements with the use of a minimally invasive FloTrac system with the latest fourth-generation algorithm in liver transplant recipients.


METHODS
Forty liver transplant recipients without atrial fibrillation, valvular pathology, or intracardiac shunt were recruited in this prospective, observational study. CO values measured by use of PAC with continuous thermodilution method (COTh) and FloTrac devices (COFT) were collected simultaneously throughout the operation for reliability validation.


RESULTS
Four hundred pairs of CO data points were collected in total. The linear regression analysis showed a high correlation coefficient (73%, P < .001). However, the percent error between COTh and COFT was 42.2%, which is worse than the established interchangeability criterion of 30%. The concordance rates were calculated at 89% and 59% by 4-quadrant plot and polar plot analysis, respectively. Neither met the preset validation criteria (>92% for the 4-quadrant plot and >90% for polar plot analyses).


CONCLUSIONS
Our study demonstrates that the CO measurements in liver transplant recipients by the latest FloTrac system and the PAC do not meet the recognized interchangeability criterion. Although the result showed improvement in linear regression analysis, it failed to display a qualified trending ability.
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.
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BF
Shih
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.
P-H
PH
Huang
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
H-P
HP
Yu
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
F-C
FC
Liu
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
C-C
CC
Lin
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan.
P C-H
PC
Chung
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.
C-Y
CY
Chen
Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Guishan, Taoyuan, Taiwan; Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.
C-J
CJ
Chang
Department of Anesthesiology, Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan. Electronic address: l12084@adm.cgmh.org.tw.
Y-F
YF
Tsai
D000465:Algorithms; D002302:Cardiac Output; D002406:Catheterization, Peripheral; D002407:Catheterization, Swan-Ganz / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D016031:Liver Transplantation; D008297:Male; D011446:Prospective Studies; D063177:Pulse Wave Analysis / Q000295:instrumentation / Q000379:methods*; D015203:Reproducibility of Results; D013815:Thermodilution