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Critical Care
Published in: Critical Care 6/2005

Open Access 01-12-2005 | Research

Pulse contour analysis after normothermic cardiopulmonary bypass in cardiac surgery patients

Authors: Michael Sander, Christian von Heymann, Achim Foer, Vera von Dossow, Joachim Grosse, Simon Dushe, Wolfgang F Konertz, Claudia D Spies

Published in: Critical Care | Issue 6/2005

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Abstract

Introduction

Monitoring of the cardiac output by continuous arterial pulse contour (COPiCCOpulse) analysis is a clinically validated procedure proved to be an alternative to the pulmonary artery catheter thermodilution cardiac output (COPACtherm) in cardiac surgical patients. There is ongoing debate, however, of whether the COPiCCOpulse is accurate after profound hemodynamic changes. The aim of this study was therefore to compare the COPiCCOpulse after cardiopulmonary bypass (CPB) with a simultaneous measurement of the COPACtherm.

Methods

After ethical approval and written informed consent, data of 45 patients were analyzed during this prospective study. During coronary artery bypass graft surgery, the aortic transpulmonary thermodilution cardiac output (COPiCCOtherm) and the COPACtherm were determined in all patients. Prior to surgery, the COPiCCOpulse was calibrated by triple transpulmonary thermodilution measurement of the COPiCCOtherm. After termination of CPB, the COPiCCOpulse was documented. Both COPACtherm and COPiCCOtherm were also simultaneously determined and documented.

Results

Regression analysis between COPACtherm and COPiCCOtherm prior to CPB showed a correlation coefficient of 0.95 (P < 0.001), and after CPB showed a correlation coefficient of 0.82 (P < 0.001). Bland-Altman analysis showed a mean bias and limits of agreement of 0.0 l/minute and -1.4 to +1.4 l/minute prior to CPB and of 0.3 l/minute and -1.9 to +2.5 l/minute after CPB, respectively. Regression analysis of COPiCCOpulse versus COPiCCOtherm and of COPiCCOpulse versus COPACtherm after CPB showed a correlation coefficient of 0.67 (P < 0.001) and 0.63 (P < 0.001), respectively. Bland-Altman analysis showed a mean bias and limits of agreement of -1.1 l/minute and -1.9 to +4.1 l/minute versus -1.4 l/minute and -4.8 to +2.0 l/minute, respectively.

Conclusion

We observed an excellent correlation of COPiCCOtherm and COPACtherm measurement prior to CPB. Pulse contour analysis did not yield reliable results with acceptable accuracy and limits of agreement under difficult conditions after weaning from CPB in cardiac surgical patients. The pulse contour analysis thus should be re-calibrated as soon as possible, to prevent false therapeutic consequences.
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Metadata
Title
Pulse contour analysis after normothermic cardiopulmonary bypass in cardiac surgery patients
Authors
Michael Sander
Christian von Heymann
Achim Foer
Vera von Dossow
Joachim Grosse
Simon Dushe
Wolfgang F Konertz
Claudia D Spies
Publication date
01-12-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3903

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