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Continuous cardiac output estimation using a new modified Fick method during off-pump coronary artery bypass graft surgery: a retrospective observational study

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Abstract

Purpose

Several technical aspects of the Fick method limit its use intraoperatively. A data-driven modification of the Fick method may enable its use in intraoperative settings.

Methods

This two-center retrospective observational study included 57 (28 and 29 in each center) patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery. Intraoperative recordings of physiological data were obtained and divided into training and test datasets. The Fick equation was used to calculate cardiac output (CO-Fick) using ventilator-determined variables, intraoperative hemoglobin level, and SvO2, with continuous thermodilution cardiac output (CCO) used as a reference. A modification CO-Fick was derived and validated: CO-Fick-AD, which adjusts the denominator of the original equation.

Results

Increased deviation between CO-Fick and CCO was observed when oxygen extraction was low. The root mean square error of CO-Fick was decreased from 6.07 L/min to 0.70 L/min after the modification. CO-Fick-AD showed a mean bias of 0.17 (95% CI 0.00–0.34) L/min, with a 36.4% (95% CI 30.6–44.4%) error. The concordance rates of CO-Fick-AD ranged from 73.3 to 87.1% depending on the time interval and exclusion zone.

Conclusions

The original Fick method is not reliable when oxygen extraction is low, but a modification using data-driven approach could enable continuous estimation of cardiac output during the dynamic intraoperative period with minimal bias. However, further improvements in precision and trending ability are needed.

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Data availability

The data that support the findings of this study are available from the corresponding author upon a reasonable request.

References

  1. Meng L, Wang Y, Zhang L, McDonagh DL. Heterogeneity and variability in pressure autoregulation of organ blood flow: lessons learned over 100+ years. Crit Care Med. 2019;47:436–48.

    Article  PubMed  Google Scholar 

  2. Meng L. Heterogeneous impact of hypotension on organ perfusion and outcomes: a narrative review. Br J Anaesth. 2021;127:845–61.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Argueta EE, Paniagua D. Thermodilution cardiac output: a concept over 250 years in the making. Cardiol Rev. 2019;27:138–44.

    Article  PubMed  Google Scholar 

  4. Drummond KE, Murphy E. Minimally invasive cardiac output monitors. Contin Educ Anaesth Crit Care Pain. 2012;12:5–10.

    Article  Google Scholar 

  5. Nadeau S, Noble WH. Limitations of cardiac output measurements by thermodilution. Can Anaesth Soc J. 1986;33:780–4.

    Article  CAS  PubMed  Google Scholar 

  6. Bootsma IT, Boerma EC, Scheeren TWL, de Lange F. The contemporary pulmonary artery catheter. Part 2: measurements, limitations, and clinical applications. J Clin Monit Comput. 2022;36:17–31.

    Article  CAS  PubMed  Google Scholar 

  7. Medin DL, Brown DT, Wesley R, Cunnion RE, Ognibene FP. Validation of continuous thermodilution cardiac output in critically ill patients with analysis of systematic errors. J Crit Care. 1998;13:184–9.

    Article  CAS  PubMed  Google Scholar 

  8. Sun Q, Rogiers P, Pauwels D, Vincent JL. Comparison of continuous thermodilution and bolus cardiac output measurements in septic shock. Intensive Care Med. 2002;28:1276–80.

    Article  PubMed  Google Scholar 

  9. Aranada M, Mihm Frederick G, Garrett S, Mihm Megan N, Pearl RG. Continuous cardiac output catheters: delay in in vitro response time after controlled flow changes. Anesthesiology. 1998;89:1592–5.

    Article  Google Scholar 

  10. Lazor MA, Pierce ET, Stanley GD, Cass JL, Halpern EF, Bode RH Jr. Evaluation of the accuracy and response time of STAT-mode continuous cardiac output. J Cardiothorac Vasc Anesth. 1997;11:432–6.

    Article  CAS  PubMed  Google Scholar 

  11. Siegel LC, Hennessy MM, Pearl RG. Delayed time response of the continuous cardiac output pulmonary artery catheter. Anesth Analg. 1996;83:1173–7.

    Article  CAS  PubMed  Google Scholar 

  12. Seely RD, Nerlich WE, Gregg DE. A comparison of cardiac output determined by the fick procedure and a direct method using the rotameter. Circulation. 1950;1:1261–6.

    Article  CAS  PubMed  Google Scholar 

  13. Visscher MB, Johnson JA. The fick principle: analysis of potential errors in its conventional application. J Appl Physiol. 1985;1953(5):635–8.

    Google Scholar 

  14. Light RB. Intrapulmonary oxygen consumption in experimental pneumococcal pneumonia. J Appl Physiol. 1985;1988(64):2490–5.

    Google Scholar 

  15. Lin SY, Chang FC, Lin JR, Chou AH, Tsai YF, Liao CC, Tsai HI, Chen CY. Increased FIO2 influences SvO2 interpretation and accuracy of Fick-based cardiac output assessment in cardiac surgery patients: a prospective randomized study. Medicine (Baltimore). 2021;100: e27020.

    Article  CAS  PubMed  Google Scholar 

  16. Lee HC, Jung CW. Vital Recorder-a free research tool for automatic recording of high-resolution time-synchronised physiological data from multiple anaesthesia devices. Sci Rep. 2018;8:1527.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Truijen J, Westerhof BE, Kim YS, Stok WJ, de Mol BA, Preckel B, Hollmann MW, van Lieshout JJ. The effect of haemodynamic and peripheral vascular variability on cardiac output monitoring: thermodilution and non-invasive pulse contour cardiac output during cardiothoracic surgery. Anaesthesia. 2018;73:1489–99.

    Article  CAS  PubMed  Google Scholar 

  18. Montenij LJ, Buhre WF, Jansen JR, Kruitwagen CL, de Waal EE. Methodology of method comparison studies evaluating the validity of cardiac output monitors: a stepwise approach and checklist. Br J Anaesth. 2016;116:750–8.

    Article  CAS  PubMed  Google Scholar 

  19. Carrasco JL, King TS, Chinchilli VM. The concordance correlation coefficient for repeated measures estimated by variance components. J Biopharm Stat. 2009;19:90–105.

    Article  PubMed  Google Scholar 

  20. Zou GY. Confidence interval estimation for the Bland-Altman limits of agreement with multiple observations per individual. Stat Methods Med Res. 2013;22:630–42.

    Article  CAS  PubMed  Google Scholar 

  21. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15:85–91.

    Article  CAS  PubMed  Google Scholar 

  22. Critchley LA, Lee A, Ho AMH. A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg. 2010;111:1180–92.

    Article  PubMed  Google Scholar 

  23. Kouz K, Michard F, Bergholz A, Vokuhl C, Briesenick L, Hoppe P, Flick M, Schön G, Saugel B. Agreement between continuous and intermittent pulmonary artery thermodilution for cardiac output measurement in perioperative and intensive care medicine: a systematic review and meta-analysis. Crit Care. 2021;25:125.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Peyton PJ, Chong SW. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision. Anesthesiology. 2010;113:1220–35.

    Article  PubMed  Google Scholar 

  25. Saugel B, Hoppe P, Nicklas JY, Kouz K, Körner A, Hempel JC, Vos JJ, Schön G, Scheeren TWL. Continuous noninvasive pulse wave analysis using finger cuff technologies for arterial blood pressure and cardiac output monitoring in perioperative and intensive care medicine: a systematic review and meta-analysis. Br J Anaesth. 2020;125:25–37.

    Article  PubMed  Google Scholar 

  26. Kusaka Y, Ohchi F, Minami T. Evaluation of the fourth-generation FloTrac/Vigileo system in comparison with the intermittent bolus thermodilution method in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33:953–60.

    Article  PubMed  Google Scholar 

  27. Maeda T, Hamaguchi E, Kubo N, Shimokawa A, Kanazawa H, Ohnishi Y. 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. 2019;33:767–76.

    Article  PubMed  Google Scholar 

  28. de Lange F, Bootsma IT, Boerma EC. Letter to the editor in response to “Agreement between continuous and intermittent pulmonary artery thermodilution for cardiac output measurement in perioperative and intensive care medicine: a systematic review and meta-analysis.” Crit Care. 2021;25:215.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nakanishi N, Yoshioka T, Okano Y, Nishimura T. Continuous Fick cardiac output measurement during exercise by monitoring of mixed venous oxygen saturation and oxygen uptake. Chest. 1993;104:419–26.

    Article  CAS  PubMed  Google Scholar 

  30. Hoeper MM, Maier R, Tongers J, Niedermeyer J, Hohlfeld JM, Hamm M, Fabel H. Determination of cardiac output by the Fick method, thermodilution, and acetylene rebreathing in pulmonary hypertension. Am J Respir Crit Care Med. 1999;160:535–41.

    Article  CAS  PubMed  Google Scholar 

  31. Liao R, Li J, Liu J. Volatile induction/maintenance of anaesthesia with sevoflurane increases jugular venous oxygen saturation and lumbar cerebrospinal fluid pressure in patients undergoing craniotomy. Eur J Anaesthesiol. 2010;27:369–76.

    Article  CAS  PubMed  Google Scholar 

  32. Jeong H, Jeong S, Lim Hoi J, Lee J, Yoo KY. Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology. 2012;116:1047–56.

    Article  CAS  PubMed  Google Scholar 

  33. Barker SJ, Shander A, Ramsay MA. Continuous noninvasive hemoglobin monitoring: a measured response to a critical review. Anesth Analg. 2016;122:565–72.

    Article  PubMed  Google Scholar 

  34. Ritchie-McLean S, Shankar R. Calculating oxygen consumption during low-flow anaesthesia. Anaesthesia. 2017;72:789.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Sincere appreciation to Dr. Sangil Park and Prof. Jin-Tae Kim for their precious guidance and invaluable advice.

Funding

This research was supported by a research fund of Chungnam National University and a research fund of Chungnam National University Hospital.

Author information

Author notes

  1. Chahyun Oh and Hyung-Chul Lee have contributed equally.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea

    Chahyun Oh, Soomin Lee, Jinsik Jung, Seok-Hwa Yoon, Yoon-Hee Kim, Youngkwon Ko & Boohwi Hong

  2. Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea

    Chahyun Oh, Soomin Lee, Seok-Hwa Yoon, Yoon-Hee Kim, Youngkwon Ko & Boohwi Hong

  3. Department of Anesthesiology and Pain Medicine Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

    Hyung-Chul Lee

  4. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea

    Hyung-Chul Lee & Soo Bin Yoon

  5. Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Korea

    Man-Shik Shim

  6. Big Data Center, Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea

    Boohwi Hong

  7. Department of Biomedical Engineering, Chungnam National University College of Medicine, 266 Munhwa-Ro(St), Jung-Gu, Daejeon, 35015, Korea

    Yunseo Ku

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  1. Chahyun Oh
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Correspondence to Yunseo Ku.

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Oh, C., Lee, HC., Lee, S. et al. Continuous cardiac output estimation using a new modified Fick method during off-pump coronary artery bypass graft surgery: a retrospective observational study. J Anesth 38, 1–9 (2024). https://doi.org/10.1007/s00540-023-03260-x

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  • DOI: https://doi.org/10.1007/s00540-023-03260-x

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