Arterial pressure-based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CI L ) and the FloTrac-Vigileo monitor (CI V ). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CI TD ). CI V -CI TD bias ranged from À1.38 (95% confidence interval ¼ À2.02 to À0.75 L/minute/m 2 , P ¼ 0.02) to À2.51 L/minute/m 2 (95% confidence interval ¼ À3.36 to À1.65 L/minute/m 2 , P < 0.001), and CI L -CI TD bias ranged from À0.65 (95% confidence interval ¼ À1.29 to À0.01 L/minute/ m 2 , P ¼ 0.047) to À1.48 L/minute/m 2 (95% confidence interval ¼ À2.37 to À0.60 L/minute/m 2 , P < 0.01). For both APCOs, bias to CI TD was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CI TD was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CI TD . In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation. Liver Transpl 16:773-782,
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