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The accuracy and trending ability of cardiac index measured by the fourth-generation FloTrac/Vigileo system™ and the Fick method in cardiac surgery patients

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Abstract

To compare the accuracy and trending ability of the cardiac index (CI) measured by FloTrac/Vigileo™ (CIFT) or derived by the Fick equation (CIFick) using E-CAiOVX (enables continuous monitoring of oxygen consumption) with that measured by thermodilution (CITD) in patients with off-pump coronary artery bypass surgery. Twenty-two patients undergoing elective off-pump coronary artery bypass surgery were included. CIFT and CIFick were determined simultaneously at six time-points during off-pump coronary artery bypass surgery. At each time-point, phenylephrine (50 µg) was administered to increase systematic vascular resistance, with CI measured before and after administration (CITD used as reference method). Agreement of each method was evaluated by Bland–Altman analysis, while trending ability was evaluated by four-quadrant plot analysis and polar plot analysis. By Bland–Altman analysis, CIFT and CIFick showed percentage errors of 49.5% and 78.6%, respectively, compared with CITD. Subgroup analysis showed a percentage error between COFT and COTD of 28.9% in patients with a CI ≥ 2.4 L/min/m2, and 78.1% in patients with a CI ≥ 2.4 L/min/m2. The concordance rate of four-quadrant plot analysis was 93.3% for CIFT and 66.7% for CIFick in datasets where CITD ≥ 2.4 L/min/m2 before and after phenylephrine administration were included. CIFT and CIFick had wide limits of agreement with CITD, and were below acceptable limits for tracking phenylephrine-induced CI changes. However, subgroup analysis showed improved accuracy and trending ability of CIFT when only points where CITD ≥ 2.4 L/min/m2 were included, while there was no improvement in CIFick accuracy or trending ability.

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Acknowledgements

We thank GE Healthcare for rental of the E-CAiOVX (GE Healthcare, WI, US), and Jane Charbonneau, DVM, from Edanz Group (http://www.edanzediting.com/ac), for editing a draft of this manuscript. We also thank the resident doctors who cared for the patients in this study.

Funding

This study was supported in part by JSPS KAKENHI (Grant Number JP17K11100).

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Authors and Affiliations

  1. Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan

    Takuma Maeda, Eisuke Hamaguchi, Naoko Kubo, Akira Shimokawa, Hiroko Kanazawa & Yoshihiko Ohnishi

  2. Division of Transfusion Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan

    Takuma Maeda

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  1. Takuma Maeda
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Correspondence to Takuma Maeda.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10877_2018_217_MOESM1_ESM.pdf

Supplementary Figure S1. Cubic spline function curves of the relationship between CITD and CI discrepancy (i.e., (CIFT − CITD)/CITD). Shaded areas represent 95% confidence intervals. (PDF 192 KB)

10877_2018_217_MOESM2_ESM.pdf

Supplementary Figure S2. Cubic spline function curves of the relationship between CITD and CI discrepancy (i.e., (CIFick − CITD)/CITD). Shaded areas represent 95% confidence intervals. (PDF 191 KB)

10877_2018_217_MOESM3_ESM.pdf

Supplementary Figure S3. Cubic spline function curves of the relationship between SVRI and CI discrepancy (i.e., (CIFT − CITD)/CITD). Shaded areas represent 95% confidence intervals. (PDF 207 KB)

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Maeda, T., Hamaguchi, E., Kubo, N. et al. The accuracy and trending ability of cardiac index measured by the fourth-generation FloTrac/Vigileo system™ and the Fick method in cardiac surgery patients. J Clin Monit Comput 33, 767–776 (2019). https://doi.org/10.1007/s10877-018-0217-1

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  • DOI: https://doi.org/10.1007/s10877-018-0217-1

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