Evaluation of a new continuous cardiac output monitor in off‐pump coronary artery surgery

Abstract

SummaryWe evaluated a new, ultra-fast response continuous cardiac output monitor in 34 adult patients undergoing off-pump coronary artery bypass graft surgery. Cardiac output was measured with the TruCCOMS Ò continuous cardiac output monitor (Aortech International plc, Lanarkshire, UK), using triplicate cold bolus thermodilution as the criterion standard, at fixed time points during surgery and during dobutamine infusion. The two techniques were compared using linear regression and Bland-Altman analysis. Overall, the study device displayed a bias of 0.4 l.min )1 with limits of agreement of +2.5 l.min )1 and )1.7 l.min )1 . The study device failed to detect the change in cardiac output caused by dobutamine accurately (y = 0.18x + 0.45; r 2 = 0.13), with an error linearly related to the magnitude of the change measured. We conclude that the device's failure to detect changes in cardiac output could be a major limitation in its clinical use in its current form.

What technique should I use to measure cardiac output?

“…This device continuously calculates the energy used by a heating filament to maintain a specified blood temperature gradient between two thermistors, hence allowing a more instantaneous CCO monitoring. The majority of recently published studies comparing CCO with ITD showed an acceptable accuracy for this technique (including truCCOMS) [7,8,10,11]. Accuracy, however, is decreased during large temperature shifts (i.e.…”

“…after cardiopulmonary bypass) [9,46]. Moreover, despite a fast response time, the ability of the truCCOMS catheter to reliably track rapid hemodynamic changes seems to be limited [10].…”

Cardiac output monitoring: an integrative perspective

“…These values are then averaged for the display of continuous cardiac output readings, which results in a delayed response time of several minutes after induction of cardiac output changes (e.g., for Opti-Q™, Abbott, Abbott Park, IL and Vigilance™catheters, Edwards LifeSiences, Irvine, CA) [7]. A so-called fast response continuous cardiac output catheter (truCCOMS™, Omega Critical Care, East Klibride, GB) allows a more synchronized continuous cardiac output monitoring [8]. The additional hemodynamic variables that can be assessed via PAC and are most often used are conventional filling pressures, pulmonary artery pressures, and mixed venous oxygen saturation (SvO 2 ).…”

Cardiac Output Monitoring: An Integrative Perspective

“…In contrast, continuous cardiac output assessment may overcome some of these [7]. A so-called fast response continuous cardiac output catheter (truCCOMS TM , Omega Critical Care, East Klibride, GB) allows a more synchronized continuous cardiac output monitoring [8]. Th e additional hemodynamic variables that can be assessed via PAC and are most often used are conventional fi lling pressures, pulmonary artery pressures, and mixed venous oxygen saturation (SvO 2 ).…”