Korean J Anesthesiol.  2011 Apr;60(4):237-243. 10.4097/kjae.2011.60.4.237.

The uncalibrated pulse contour cardiac output during off-pump coronary bypass surgery: performance in patients with a low cardiac output status and a reduced left ventricular function

• Jo YY
• Song JW
• Yoo YC
• Park JY
• Shim JK
• Kwak YL

• KMID: 2092282
• DOI: http://doi.org/10.4097/kjae.2011.60.4.237

Abstract

BACKGROUND
We compared the continuous cardiac index measured by the FloTrac/Vigileo(TM) system (FCI) to that measured by a pulmonary artery catheter (CCI) with emphasis on the accuracy of the FCI in patients with a decreased left ventricular ejection fraction (LVEF) and a low cardiac output status during off-pump coronary bypass surgery (OPCAB). We also assessed the influence of several factors affecting the pulse contour, such as the mean arterial pressure (MAP), the systemic vascular resistance index (SVRI) and the use of norepinephrine.
METHODS
Fifty patients who were undergoing OPCAB (30 patients with a LVEF > or = 40%, 20 patients with a LVEF < 40%) were enrolled. The FCI and CCI were measured and we performed a Bland-Altman analysis. Subgroup analyses were done according to the LVEF (< 40%), the CCI (< or = 2.4 L/min/m), the MAP (60-80 mmHg), the SVRI (1,600-2,600 dyne/s/cm5/m2) and the use of norepinephrine.
RESULTS
The FCI was reliable at all the time points of measurement with an overall bias and limit of agreement of -0.07 and 0.67 L/min/m2, respectively, resulting in a percentage error of 26.9%. The percentage errors in the patients with a decreased LVEF and in a low cardiac output status were 28.2% and 22.3%, respectively. However, the percentage error in the 91 data pairs outside the normal range of the SVRI was 40.2%.
CONCLUSIONS
The cardiac output measured by the FloTrac/Vigileo(TM) system was reliable even in patients with a decreased LVEF and in a low cardiac output status during OPCAB. Acceptable agreement was also noted during the period of heart displacement and grafting of the obtuse marginalis branch.

Keyword

Cardiac output; Measurement techniques; Off pump coronary artery bypass

MeSH Terms

Arterial Pressure
Bias (Epidemiology)
Cardiac Output
Cardiac Output, Low
Catheters
Coronary Artery Bypass, Off-Pump
Displacement (Psychology)
Heart
Humans
Pulmonary Artery
Reference Values
Stroke Volume
Transplants
Vascular Resistance
Ventricular Function, Left