Cardiac output estimation by pulse wave analysis using the pressure recording analytical method and intermittent pulmonary artery thermodilution

Greiwe, Gillis; Luehsen, Katharina; Hapfelmeier, Alexander; Rogge, Dorothea E.; Kubik, Mathias; Schulte‐Uentrop, Leonie; Saugel, Bernd

doi:10.1097/eja.0000000000001227

Cited by 12 publications

(13 citation statements)

References 29 publications

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“…CI was measured using the MostCareUp system (Vygon), a system for invasive pulse wave analysis. [7][8][9] Anesthesiologists were blinded to these CI measurements. Dynamic response of the arterial catheter/tubing/transducersystem was confirmed before study measurements with fast-flush tests; we also confirmed that transducers were correctly leveled and zeroed.…”

Section: Study Measurementsmentioning

confidence: 99%

The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study

Kouz¹,

Bergholz²,

Timmermann³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Cardiac output is an important hemodynamic variable and determines oxygen delivery. In contrast to blood pressure, cardiac output is rarely measured even in high-risk surgical patients, suggesting that clinicians consider blood pressure to be a reasonable indicator of systemic blood flow. However, the relationship depends on constant vascular tone and volume, both of which routinely vary during anesthesia and surgery. We therefore tested the hypothesis that there is no clinically meaningful correlation between mean arterial pressure and cardiac index in major abdominal surgery patients. METHODS: In this prospective observational study, we assessed the relationship between mean arterial pressure and cardiac index in 100 patients having major abdominal surgery under general anesthesia. RESULTS: The pooled within-patient correlation coefficient calculated using meta-analysis methods was r = 0.34 (95% confidence interval, 0.28-0.40). Linear regression using a linear mixed effects model of cardiac index on mean arterial pressure revealed that cardiac index increases by 0.014 L•min −1 •m −2 for each 1 mm Hg increase in mean arterial pressure. The 95% Wald confidence interval of this slope was 0.011 to 0.018 L•min −1 •m −2 •mm Hg −1 and thus within predefined equivalence margins of −0.03 and 0.03 L•min −1 •m −2 •mm Hg −1 , thereby demonstrating lack of clinically meaningful association between mean arterial pressure and cardiac index. CONCLUSIONS: There is no clinically meaningful correlation between mean arterial pressure and cardiac index in patients having major abdominal surgery. Intraoperative blood pressure is thus a poor surrogate for cardiac index. (Anesth Analg 2022;134:322-9) KEY POINTS• Question: What is the relationship between mean arterial pressure and cardiac index in patients having major abdominal surgery under general anesthesia? • Findings: There was no clinically meaningful correlation between mean arterial pressure and cardiac index in patients having major abdominal surgery. • Meaning: Mean arterial pressure should not be considered even a rough indicator of cardiac index. GLOSSARYCI = cardiac index; CO = cardiac output; MAP = mean arterial pressure; STROBE = Strenghtening the Reporting of Observational Studies in Epidemiology; SVR = systemic vascular resistance C ardiac output (CO) is an important hemodynamic variable because CO-together with arterial oxygen content-determines oxygen delivery. 1 CO-guided hemodynamic management may improve postoperative outcomes in high-risk surgical patients. 2,3

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Section: Study Measurementsmentioning

confidence: 99%

The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study

Kouz¹,

Bergholz²,

Timmermann³

et al. 2021

Anesthesia &Amp; Analgesia

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“…Additionally, an automated waveform filter, which assists the user in ensuring an optimal quality of the arterial pulse wave, is integrated in PRAM. PRAM has been investigated in different clinical settings and patient cohorts with mostly promising results 6,8 but there is not enough evidence to transfer the results of PRAM-CO in critically ill patients to vvECMO patients.…”

Section: Discussionmentioning

confidence: 99%

“…6 It is implemented in the MostCareUp monitoring system (Vygon, Ecouen, France) and has been validated for CO measurements in adult surgical and critically ill patients before. [6][7][8] We aimed to compare CO measurements by PRAM (PRAM-CO; test method) with CO measurements by transthoracic echocardiography (TTE) (TTE-CO; reference method) in patients with vvECMO therapy. We thus performed a prospective clinical method comparison study to test the hypothesis that the agreement between PRAM-CO and TTE-CO is clinically acceptable.…”

Section: Introductionmentioning

confidence: 99%

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Agreement between cardiac output measurements by pulse wave analysis using the Pressure Recording Analytical Method and transthoracic echocardiography in patients with veno-venous extracorporeal membrane oxygenation therapy

Greiwe

Flick

Hapfelmeier

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDMeasuring cardiac output (CO) is important in patients treated with veno-venous extracorporeal membrane oxygenation (vvECMO) because vvECMO flow and CO need to be balanced. Uncalibrated pulse wave analysis with the Pressure Recording Analytical Method (PRAM) may be suitable to measure CO in patients with vvECMO therapy.OBJECTIVETo assess the agreement between CO measured by PRAM (PRAM-CO; test method) and CO measured by transthoracic echocardiography (TTE-CO; reference method).DESIGNA prospective observational method comparison study.SETTINGThe ICU of a German university hospital between March and December 2021.PATIENTSThirty one adult patients with respiratory failure requiring vvECMO therapy: 29 of the 31 patients (94%) were treated for COVID-19 related respiratory failure.MAIN OUTCOME MEASURESPRAM-CO and TTE-CO were measured simultaneously at two time points in each patient with at least 20 min between measurements. A radial or femoral arterial catheter-derived blood pressure waveform was used for PRAM-CO measurements. TTE-CO measurements were conducted using the pulsed wave Doppler-derived velocity time integral of the left ventricular outflow tract (LVOT) and the corresponding LVOT diameter. PRAM-CO and TTE-CO were compared using Bland–Altman analysis and the percentage error (PE). We defined a PE of <30% as clinically acceptable.RESULTSMean ± SD PRAM-CO was 6.86 ± 1.49 l min−1 and mean TTE-CO was 6.94 ± 1.58 l min−1. The mean of the differences between PRAM-CO and TTE-CO was 0.09 ± 0.73 l min−1 with a lower 95% limit of agreement of −1.34 l min−1 and an upper 95% limit of agreement of 1.51 l min−1. The PE was 21%.CONCLUSIONSThe agreement between PRAM-CO and TTE-CO is clinically acceptable in adult patients with vvECMO therapy.

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“…The MostCare system (Vygon, France) is currently the only commercially available minimally invasive uncalibrated pulse wave analysis system, and its CO values showed good agreement with those obtained by pulmonary artery thermodilution. 25 It uses the pressure recording analytical method algorithm to continuously estimate CO. The algorithm identifies specific ephemeral points of instability of the arterial blood pressure waveform that are mainly due to wave reflections by analyzing the arterial blood pressure waveform in a very high resolution.…”

Section: Minimally Invasive Uncalibrated Pulse Wave Analysismentioning

confidence: 99%

Pulse Wave Analysis to Estimate Cardiac Output

et al. 2020

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Cardiac output estimation by pulse wave analysis using the pressure recording analytical method and intermittent pulmonary artery thermodilution

Cited by 12 publications

References 29 publications

The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study

The Relation Between Mean Arterial Pressure and Cardiac Index in Major Abdominal Surgery Patients: A Prospective Observational Cohort Study

Agreement between cardiac output measurements by pulse wave analysis using the Pressure Recording Analytical Method and transthoracic echocardiography in patients with veno-venous extracorporeal membrane oxygenation therapy

Pulse Wave Analysis to Estimate Cardiac Output

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