Top

Journal of Clinical Monitoring and Computing

Published in:

01-04-2018 | Original Research

A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients

Authors: Julia Y. Wagner, Annmarie Körner, Leonie Schulte-Uentrop, Mathias Kubik, Hermann Reichenspurner, Stefan Kluge, Daniel A. Reuter, Bernd Saugel

Published in: Journal of Clinical Monitoring and Computing | Issue 2/2018

Abstract

The CNAP technology (CNSystems Medizintechnik AG, Graz, Austria) allows continuous noninvasive arterial pressure waveform recording based on the volume clamp method and estimation of cardiac output (CO) by pulse contour analysis. We compared CNAP-derived CO measurements (CNCO) with intermittent invasive CO measurements (pulmonary artery catheter; PAC-CO) in postoperative cardiothoracic surgery patients. In 51 intensive care unit patients after cardiothoracic surgery, we measured PAC-CO (criterion standard) and CNCO at three different time points. We conducted two separate comparative analyses: (1) CNCO auto-calibrated to biometric patient data (CNCO_bio) versus PAC-CO and (2) CNCO calibrated to the first simultaneously measured PAC-CO value (CNCO_cal) versus PAC-CO. The agreement between the two methods was statistically assessed by Bland–Altman analysis and the percentage error. In a subgroup of patients, a passive leg raising maneuver was performed for clinical indications and we present the changes in PAC-CO and CNCO in four-quadrant plots (exclusion zone 0.5 L/min) in order to evaluate the trending ability of CNCO. The mean difference between CNCO_bio and PAC-CO was +0.5 L/min (standard deviation ± 1.3 L/min; 95% limits of agreement −1.9 to +3.0 L/min). The percentage error was 49%. The concordance rate was 100%. For CNCOcal, the mean difference was −0.3 L/min (±0.5 L/min; −1.2 to +0.7 L/min) with a percentage error of 19%. In this clinical study in cardiothoracic surgery patients, CNCO_cal showed good agreement when compared with PAC-CO. For CNCO_bio, we observed a higher percentage error and good trending ability (concordance rate 100%).

Porhomayon J, El-Solh A, Papadakos P, Nader ND. Cardiac output monitoring devices: an analytic review. Intern Emerg Med. 2012;7:163–71. doi:10.1007/s11739-011-0738-9.CrossRefPubMed

Ganz W, Donoso R, Marcus HS, Forrester JS, Swan HJ. A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol. 1971;27:392–6. doi:10.1016/0002-9149(71)90436-X.CrossRefPubMed

Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. New Engl J Med. 1970;283:447–51. doi:10.1056/NEJM197008272830902.CrossRefPubMed

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev. 2013;2:CD003408. doi:10.1002/14651858.CD003408.pub3.

Richard C, Monnet X, Teboul JL. Pulmonary artery catheter monitoring in 2011. Curr Opin Crit Care. 2011;17:296–302. doi:10.1097/MCC.0b013e3283466b85.CrossRefPubMed

Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Luscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C, Authors/Task Force Members. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383–431. doi:10.1093/eurheartj/ehu282.CrossRefPubMed

Alhashemi JA, Cecconi M, Hofer CK. Cardiac output monitoring: an integrative perspective. Crit Care. 2011;15:214. doi:10.1186/cc9996.CrossRefPubMedPubMedCentral

Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. J Cardiothor Vasc Anesth. 2013;27:121–34. doi:10.1053/j.jvca.2012.03.022.CrossRef

Saugel B, Cecconi M, Wagner JY, Reuter DA. Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. Br J Anaesth. 2015;114:562–75. doi:10.1093/bja/aeu447.CrossRefPubMed

10.

Thiele RH, Bartels K, Gan TJ. Cardiac output monitoring: a contemporary assessment and review. Crit Care Med. 2015;43:177–85. doi:10.1097/ccm.0000000000000608.CrossRefPubMed

11.

Saugel B, Dueck R, Wagner JY. Measurement of blood pressure. Best Pract Res Clin Anaesthesiol. 2014;28:309–22. doi:10.1016/j.bpa.2014.08.001.CrossRefPubMed

12.

Wagner JY, Grond J, Fortin J, Negulescu I, Schofthaler M, Saugel B. Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour. J Clin Monit Comput. 2016;30:487–93. doi:10.1007/s10877-015-9744-1.CrossRefPubMed

13.

Ilies C, Bauer M, Berg P, Rosenberg J, Hedderich J, Bein B, Hinz J, Hanss R. Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth. 2012;108:202–10. doi:10.1093/bja/aer394.CrossRefPubMed

14.

Smolle KH, Schmid M, Prettenthaler H, Weger C. The accuracy of the CNAP(R) device compared with invasive radial artery measurements for providing continuous noninvasive arterial blood pressure readings at a medical intensive care unit: a method-comparison study. Anesth Analg. 2015;121:1508–16. doi:10.1213/ane.0000000000000965.CrossRefPubMed

15.

Wagner JY, Prantner JS, Meidert AS, Hapfelmeier A, Schmid RM, Saugel B. Noninvasive continuous versus intermittent arterial pressure monitoring: evaluation of the vascular unloading technique (CNAP device) in the emergency department. Scand J Trauma Resusc Emerg Med. 2014;22:8. doi:10.1186/1757-7241-22-8.CrossRefPubMedPubMedCentral

16.

Monnet X, Teboul JL. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19:18. doi:10.1186/s13054-014-0708-5.CrossRefPubMedPubMedCentral

17.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF, STARD Group. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. doi:10.1136/bmj.h5527.CrossRefPubMedPubMedCentral

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. doi:10.1093/bja/aew094.CrossRefPubMed

19.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefPubMed

20.

Wagner JY, Negulescu I, Schofthaler M, Hapfelmeier A, Meidert AS, Huber W, Schmid RM, Saugel B. Continuous noninvasive arterial pressure measurement using the volume clamp method: an evaluation of the CNAP device in intensive care unit patients. J Clin Monit Comput. 2015;29(6):807–13. doi:10.1007/s10877-015-9670-2.CrossRefPubMed

21.

Penaz J. (1973) Photoelectric measurement of blood pressure, volume and flow in the finger. Digest of the 10th International Conference on Medical and Biological Engineering, Dresden.

22.

Fortin J, Marte W, Grullenberger R, Hacker A, Habenbacher W, Heller A, Wagner C, Wach P, Skrabal F. Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops. Comput Biol Med. 2006;36:941–57. doi:10.1016/j.compbiomed.2005.04.003.CrossRefPubMed

23.

Fortin J, Wellisch A, Maier K. CNAP—evolution of continuous non-invasive arterial blood pressure monitoring. Biomed Tech. 2013. doi:10.1515/bmt-2013-4179.

24.

Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17:571–82. doi:10.1080/10543400701329422.CrossRefPubMed

25.

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.CrossRefPubMed

26.

Saugel B, Grothe O, Wagner JY. Tracking changes in cardiac output: statistical considerations on the 4-quadrant plot and the polar plot methodology. Anesth Analg. 2015;121:514–24. doi:10.1213/ane.0000000000000725.CrossRefPubMed

27.

Critchley LA, Lee A, Ho AM. A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output. Anesth Analg. 2010;111:1180–92. doi:10.1213/ANE.0b013e3181f08a5b.CrossRefPubMed

28.

Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, Pinsky MR, Hofer CK, Teboul JL, de Boode WP, Scolletta S, Vieillard-Baron A, De Backer D, Walley KR, Maggiorini M, Singer M. Clinical review: update on hemodynamic monitoring—a consensus of 16. Crit Care. 2011;15:229. doi:10.1186/cc10291.CrossRefPubMedPubMedCentral

29.

Saugel B, Reuter DA. Are we ready for the age of non-invasive haemodynamic monitoring? Br J Anaesth. 2014;113:340–3. doi:10.1093/bja/aeu145.CrossRefPubMed

30.

Thiele RH. Cardiac bulldozers, backhoes, and blood pressure. Anesth Analg. 2015;121:1417–9. doi:10.1213/ane.0000000000000983.CrossRefPubMed

31.

Saugel B, Meidert AS, Langwieser N, Wagner JY, Fassio F, Hapfelmeier A, Prechtl LM, Huber W, Schmid RM, Godje O. An autocalibrating algorithm for non-invasive cardiac output determination based on the analysis of an arterial pressure waveform recorded with radial artery applanation tonometry: a proof of concept pilot analysis. J Clin Monit Comput. 2014;28:357–62. doi:10.1007/s10877-013-9540-8.CrossRefPubMed

32.

Wagner JY, Sarwari H, Schon G, Kubik M, Kluge S, Reichenspurner H, Reuter DA, Saugel B. Radial artery applanation tonometry for continuous noninvasive cardiac output measurement: a comparison with intermittent pulmonary artery thermodilution in patients after cardiothoracic surgery. Crit Care Med. 2015;43:1423–8. doi:10.1097/CCM.0000000000000979.CrossRefPubMed

33.

Broch O, Renner J, Gruenewald M, Meybohm P, Schottler J, Caliebe A, Steinfath M, Malbrain M, Bein B. A comparison of the Nexfin(R) and transcardiopulmonary thermodilution to estimate cardiac output during coronary artery surgery. Anaesthesia. 2012;67:377–83. doi:10.1111/j.1365-2044.2011.07018.x.CrossRefPubMed

34.

Bubenek-Turconi SI, Craciun M, Miclea I, Perel A. Noninvasive continuous cardiac output by the Nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output. Anesth Analg. 2013;117:366–72. doi:10.1213/ANE.0b013e31829562c3.CrossRefPubMed

35.

Saugel B, Wagner JY, Reuter DA. Haemodynamic monitoring: the inseparable relation of accuracy and trending. Br J Anaesth. 2015;115:943. doi:10.1093/bja/aev391.CrossRefPubMed

36.

Cecconi M, Rhodes A, Poloniecki J, Della Rocca G, Grounds RM. Bench-to-bedside review: the importance of the precision of the reference technique in method comparison studies—with specific reference to the measurement of cardiac output. Crit Care. 2009;13:201. doi:10.1186/cc7129.CrossRefPubMedPubMedCentral

37.

Hapfelmeier A, Cecconi M, Saugel B. Cardiac output method comparison studies: the relation of the precision of agreement and the precision of method. J Clin Monit Comput. 2015;30:149–55. doi:10.1007/s10877-015-9711-x.CrossRefPubMed

38.

Critchley LA. Bias and precision statistics: should we still adhere to the 30% benchmark for cardiac output monitor validation studies? Anesthesiology. 2011;114:1245. doi:10.1097/ALN.0b013e318215e1e5. [author reply 1245–1246].CrossRefPubMed

39.

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. doi:10.1097/ALN.0b013e3181ee3130.CrossRefPubMed

40.

Wagner JY, Saugel B. When should we adopt continuous noninvasive hemodynamic monitoring technologies into clinical routine? J Clin Monit Comput. 2015;29:1–3. doi:10.1007/s10877-014-9619-x.CrossRefPubMed

Title: A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients
Authors: Julia Y. Wagner
Annmarie Körner
Leonie Schulte-Uentrop
Mathias Kubik
Hermann Reichenspurner
Stefan Kluge
Daniel A. Reuter
Bernd Saugel
Publication date: 01-04-2018
Publisher: Springer Netherlands
Published in: Journal of Clinical Monitoring and Computing / Issue 2/2018
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-017-0027-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2018

A validation method for near-infrared spectroscopy based tissue oximeters for cerebral and somatic tissue oxygen saturation measurements

Microvascular reactivity measured by vascular occlusion test is an independent predictor for postoperative bleeding in patients undergoing cardiac surgery

Respiratory variation in peak aortic velocity accurately predicts fluid responsiveness in children undergoing neurosurgery under general anesthesia

Comparing measurement methods using linear least squares regression

Oral capnography is more effective than nasal capnography during sedative upper gastrointestinal endoscopy

Predicting fluid responsiveness in whom? A simulated example of patient spectrum influencing the receiver operating characteristics curve