Uncalibrated Radial and Femoral Arterial Pressure Waveform Analysis for Continuous Cardiac Output Measurement: An Evaluation in Cardiac Surgery Patients

Objectives

Arterial pressure waveform analysis is a less invasive alternative to the pulmonary artery catheter for continuous cardiac output (CO) measurement. Uncalibrated and calibrated systems are actually available (ie, the FloTrac/Vigileo system [Edwards Lifesciences, Irvine, CA] and the PiCCOplus system [Pulsion Medical Systems, Munich, Germany]). According to the FloTrac/Vigileo manufacturer, reliable measurements can be performed using any existing arterial catheter. The aim of this study was to evaluate CO determined by the FloTrac/Vigileo system using a radial (FCO_radial) and femoral arterial catheter (FCO_femoral) as well as the PiCCOplus system (PCO). Intermittent pulmonary artery thermodilution (ICO) was used as primary reference technique.

Design

A prospective clinical study.

Setting

A teaching hospital, single center.

Participants

Twenty-six cardiac surgery patients.

Interventions

Perioperative CO measurements.

Measurements and Main Results

CO was assessed at predefined measurement points. FCO_radial, FCO_femoral, and PCO were recorded after the induction of anesthesia, after sternotomy, at skin closure, after intensive care unit transfer, and during intensive care unit stay 12 and 24 hours after study initiation. ICO was determined as the mean of 3 bolus injections. Bland-Altman analysis revealed comparable mean bias and limits of agreement for FCO_radial, FCO_femoral, and PCO when compared with ICO. There was a decreased agreement for all devices in the postoperative period. However, a consistently close agreement was observed for the direct comparison between FCO_radial and FCO_femoral.

Conclusions

Performance of the FloTrac/Vigileo system via radial as well as femoral access and the PiCCOplus monitoring for cardiac output measurement were comparable when tested against intermittent thermodilution in cardiac surgery patients.

Key Words: cardiac output measurement, pulmonary artery thermodilution, pulse-wave analysis, FloTrac, PiCCO