Arterial pulse contour analysis trending of cardiac output: hemodynamic manipulations during cerebral arteriovenous malformation resection.

Abstract

Intravascular pressure and cardiac output monitoring are frequently performed in the operating room and intensive care unit. Currently, cardiac output is only measured intermittently, although continuous measurement would be preferable. One method proposed for measuring cardiac output continuously is arterial waveform pulse contour analysis. This study examines the utility of trending cardiac output using pulse contour analysis during manipulations of blood pressure. Eleven patients were studied while undergoing resection of cerebral arteriovenous malformations. Cardiac output measured by pulse contour analysis was compared with thermodilution cardiac output measurements in patients subjected to induced hypotension with esmolol and restoration of blood pressure with phenylephrine. Esmolol infusion resulted in a decrease in mean arterial pressure from 81 +/- 13 to 62 +/- 7 mm Hg (p < 0.025), a decrease in thermodilution cardiac output from 6.4 +/- 0.9 to 4.4 +/- 1.1 L/min (p < 0.025), and a decrease in pulse contour cardiac output from 6.2 +/- 1.0 to 4.5 +/- 0.9 L/min. Phenylephrine increased mean arterial pressure from 68 +/- 6 to 95 +/- 9 mm Hg with no change in either thermodilution or pulse contour cardiac output. This study demonstrates that during surgery for arteriovenous malformations in the brain, the pulse contour method was able to reflect cardiac output accurately during induced hypotension with esmolol and during restoration of blood pressure with phenylephrine.