Abstract
Objective: The purpose of this study was to determine the correlation between cardiac index (CI) measurements made using intermittent thermodilution (ITD) technique by pulmonary artery catheter (PAC) and arterial pulse-contour analysis by FloTrac. Design: Prospective observational study. Setting: Cardiac surgery unit in a 350 bedded tertiary care hospital in India. Participants: 31 adult patients undergoing elective off-pump coronary artery bypass grafting (OPCABG) Interventions: CI measurements performed by the two different methods at six time points during the surgery (before skin incision, during grafting of left anterior descending artery, obtuse marginal artery and right coronary/ posterior descending artery, after protamine administration and after shifting the patient to recovery room). Measurements and results: The techniques a weak correlation at all six time points during the OPCABG. The mean bias of 0.85 L/min/m2 and precision of 0.55 was found in the study population. The percentage error calculated using Critchley s criteria was found to be 46%. Conclusion: CI measurements obtained using FloTrac showed a limited correlation with those acquired by ITD technique at different stages of OPCABG. Further studies are required in other patient populations and clinical situations.
Highlights
The use of Off Pump Coronary Artery Bypass Grafting (OPCABG) is gaining widespread acceptance as the preferred choice for myocardial revascularization [1,2]
cardiac index (CI) measurements obtained using FloTrac showed a limited correlation with those acquired by Intermittent Thermodilution Technique (ITD) technique at different stages of OPCABG
The routine use of Pulmonary Artery Catheter (PAC) has been questioned in the literature for the lack of statistical evidence of its benefit and associated problems such as longer time required for its placement, cost, intermittent nature leading to potential for delay and rare complications like pulmonary artery rupture [8]
Summary
The use of Off Pump Coronary Artery Bypass Grafting (OPCABG) is gaining widespread acceptance as the preferred choice for myocardial revascularization [1,2]. CO monitoring has been accomplished by the Intermittent Thermodilution Technique (ITD) using Pulmonary Artery Catheter (PAC) [6]. Considering its potential advantage of providing additional information about cardiac filling pressures, pulmonary artery pressures and mixed venous oxygen saturation, PAC still remains the favored technique by many clinicians [7]. The routine use of PAC has been questioned in the literature for the lack of statistical evidence of its benefit and associated problems such as longer time required for its placement, cost, intermittent nature leading to potential for delay and rare complications like pulmonary artery rupture [8]. FloTrac by Edwards Life sciences is one of such devices based on the pulse contour analysis that estimates the cardiac output by beat to beat stroke volume analysis, based on Windkessel model described by Otto Frank in 1899 [10]
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