title: Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution.
abstract: Objective.Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB).Methods.Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1-9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated.Results.There was only a poor correlation between COTPTDand COX1-9during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability.Conclusions.Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Ole
authors.identifier: 0000-0002-3309-0909
authors.initials: O
authors.lastname: Broch
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gruenewald
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Masing
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Huenges
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schleswig-Holstein, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
mesh_terms: D000465:Algorithms; D001795:Blood Pressure Determination / Q000379:methods; D002302:Cardiac Output / Q000502:physiology*; D001026:Coronary Artery Bypass / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011651:Pulmonary Artery / Q000502:physiology; D063177:Pulse Wave Analysis / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013815:Thermodilution / Q000379:methods*