Accuracy of noninvasive estimated continuous cardiac output (esCCO) compared to thermodilution cardiac output: a pilot study in cardiac patients

Timothy R Ball, Anthony P Tricinella, B Alex Kimbrough, Sarah Luna, David F Gloyna, Frank J Villamaria, William C Culp
Journal of Cardiothoracic and Vascular Anesthesia 2013, 27 (6): 1128-32

OBJECTIVE: To compare the noninvasive estimated continuous cardiac output (esCCO), device-derived cardiac output (CO) to simultaneous pulmonary artery catheter (PAC) thermodilution (TD) CO.

DESIGN: A prospective study comparing pulse wave transit time (estimated continuous cardiac output, esCCO; Nihon Kohden, Tokyo, Japan) to intermittent TD CO.

SETTING: One academic hospital.

PARTICIPANTS: Patients presenting for cardiac surgery.

INTERVENTIONS: Intraoperative CO measurements at 4 distinct time points (after induction, after sternotomy, after cardiopulmonary bypass, and after chest closure).

MEASUREMENTS AND MAIN RESULTS: The study population consisted of American Society of Anesthesiologists (ASA) IV subjects, 27 (77%) males and 8 (23%) females, with a mean age of 64.6 ± 12.2 years. Data points from esCCO and TD were collected simultaneously and means per time point compared using Bland-Altman, Pearson R coefficient, and percent error. Mean TD CO for the study was 5.4 L/min. The Pearson R coefficient, percent error, and bias in L/min were: 0.57, 44%, 0.66 (after induction); 0.54, 51%, 0.88 (after sternotomy); 0.60, 60%, 0.95 (after cardiopulmonary bypass); and 0.57, 60%, 0.75 (after chest closure) respectively.

CONCLUSIONS: esCCO is easy to use and provides continuous CO measurements, but has wide limits of agreement and large percentage errors with a consistently positive bias in comparison to TD.

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