Comparing hemodynamic effects with three different measurement devices, of two methods of external leg compression versus passive leg raising in patients after cardiac surgery

Abstract

External leg compression (ELC) may increase cardiac output (CO) in fluid-responsive patients like passive leg raising (PLR). We compared the hemodynamic effects of two methods of ELC and PLR measured by thermodilution (COtd), pressure curve analysis Modelflow™ (COmf) and ultra-sound HemoSonic™ (COhs), to evaluate the method with the greatest hemodynamic effect and the most accurate less invasive method to measure that effect. We compared hemodynamic effects of two different ELC methods (circular, A (n=16), vs. wide, B (n=13), bandages inflated to 30cm H2O for 15min) with PLR prior to each ELC method, in 29 post-operative cardiac surgical patients. Hemodynamic responses were measured with COtd, COmf and COhs. PLR A increased COtd from 6.1±1.7 to 6.3±1.8L·min(-1) (P=0.016), and increased COhs from 4.9±1.5 to 5.3±1.6L·min(-1) (P=0.001), but did not increase COmf. ELC A increased COtd from 6.4±1.8 to 6.7±1.9L·min(-1) (P=0.001) and COmf from 6.9±1.7 to 7.1±1.8L·min(-1) (P=0.021), but did not increase COhs. ELC A increased COtd and COmf as in PLR A. PLR B increased COtd from 5.4±1.3 to 5.8±1.4L·min(-1) (P<0.001), and COhs from 5.0±1.0 to 5.4±1.0L·min(-1) (P=0.013), but not COmf. ELC B increased COtd from 5.2±1.2 to 5.4±1.1L·min(-1) (P=0.003), but less than during PLR B (P=0.012), while COmf and COhs did not change. Bland-Altman and polar plots showed lower limits of agreement with changes in COtd for COmf than for COhs. The circular leg compression increases CO more than bandage compression, and is able to increase CO as in PLR. The less invasive Modelflow™ can detect these changes reasonably well.