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Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter

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Abstract

We compared the similarity of cardiac-output (CO) estimates between available bolus thermodilution pulmonary-artery catheters (PAC), arterial pulse-contour analysis (LiDCOplus™, FloTrac™ and PiCCOplus™), and bioreactance (NICOM™). Repetitive simultaneous estimates of CO obtained from the above devices were compared in 21 cardiac-surgery patients during the first 2 h post-surgery. Mean and absolute values for CO across the devices were compared by ANOVA, Bland–Altman, Pearson moment, and linear-regression analyses. Twenty-one simultaneous CO measurements were made before and after therapeutic interventions. Mean PAC CO (5.7 ± 1.5 L min) was similar to LiDCO™, FloTrac™, PiCCO™, and NICOM™ CO (6.0 ± 1.9, 5.9 ± 1.0, 5.7 ± 1.8, 5.3 ± 1.0 L min, respectively). Mean CO bias between each paired method was −0.10 (PAC–LiDCO), 0.18 (PAC–PiCCO), −0.40 (PAC–FloTrac), −0.71 (PAC–NICOM), 0.28 (LiDCO–PiCCO), 0.39 (LiDCO–FloTrac), −0.97 (NICOM–LiDCO), 0.61 (PiCCO–FloTrac), −1.0 (NICOM–FloTrac), −0.73 (NICOM–PiCCO) L/min, with limits of agreement (1.96 SD, ±95% CI) of ± 2.01, ±2.35, ±2.27, ±2.70, ±1.97, ±2.17, ±3.51, ±2.87, ±2.40, and ± 3.14 L min, respectively, and the percentage error for each of the paired devices was 35, 41, 40, 47, 33, 36, 59, 50, 42, and 55%, respectively. From Pearson moment analysis, dynamic changes in CO, estimated by each device, showed good cross-correlations. Although all devices studied recorded similar mean CO values, which dynamically changed in similar directions, they have markedly different bias and precision values relative to each other. Thus, results from prior studies that have used one device to estimate CO cannot be used to validate others devices.

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Abbreviations

CO:

Cardiac output

ICU:

Intensive-care unit

PAC:

Pulmonary-artery catheter

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Acknowledgements

The authors wish to thank the Cardio thoracic Intensive Care Unit nursing staff at Presbyterian University Hospital, UPMC, for their support in conducting this study. We also appreciate Edwards Life Sciences (Irvine, CA, USA), Pulsion (Munich, Germany), Cheetah Medical (Vancouver, WA, USA), and LiDCO (London, UK) for providing us with the devices, the supplies, and training for this study. This work was supported in part by NIH grants HL67181 and HL073198.

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Authors and Affiliations

  1. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Bouchra Lamia, Hyung Kook Kim & Michael R. Pinsky

  2. Pulmonary and Critical Care Department, Normandie Univ, UNIROUEN, EA3830, Rouen University Hospital and Le Havre Hospital Complex, University of Rouen, 22 Boulevard Gambetta, F76000, Rouen, France

    Bouchra Lamia

  3. Pulmonary Department, Le Havre Hospital Complex, Le Havre, France

    Bouchra Lamia

  4. Department Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Donald A. Severyn

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  1. Bouchra Lamia
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Correspondence to Bouchra Lamia.

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Conflict of interest

Bouchra Lamia, Hyung Kook Kim, Don Severyn: none declared. Michael R. Pinsky is a member of the medical advisory boards for LiDCO Ltd and Edwards LifeSciences, Inc. He has stock options with LiDCO Ltd and Cheetah Medical. He has received honoraria for lectures from Edwards LifeSciences, LiDCO, and Cheetah Medical. He has received financial support to conduct laboratory research from Pulsion Ltd.

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Lamia, B., Kim, H.K., Severyn, D.A. et al. Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter. J Clin Monit Comput 32, 33–43 (2018). https://doi.org/10.1007/s10877-017-9983-4

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