Evaluation of New Calibrated Pulse-Wave Analysis (VolumeViewTM/EV1000TM) for Cardiac Output Monitoring Undergoing Living Donor Liver Transplantation

Abstract

BackgroundIntrapulmonary thermodilution technique using a pulmonary artery catheter is widely used for measuring cardiac output (CO) in patients undergoing liver transplantation. However, its invasiveness and associated complications have led to an interest in less invasive modalities. Thus, we aimed to evaluate whether the new calibrated pulse-wave analysis method monitoring (VolumeViewTM/EV1000TM) is interchangeable with intrapulmonary thermodilution technique.MethodsTwenty-eight patients undergoing living donor liver transplantation were enrolled in this prospective observational study. COs were recorded automatically by the two devices and compared simultaneously at 10-minute intervals. The agreement of absolute CO values and the tracking ability of CO changes trends were compared. A Bland-Altman analysis with percentage errors and concordance rate for trend analysis using both a 4-quadrant plot and a polar plot were performed on the data.ResultsA total of 375 paired datasets from 25 patients were included in analysis. COs measured by intrapulmonary thermodilution ranged from 3.8–13.7 L/min. The mean CO difference between the two techniques was 0.57 L/min, and the 95% limits of agreement were -0.98 L/min to 2.12 L/min with a percentage error of 42.3%. The percentage errors in the dissection, anhepatic, and reperfusion phase were 30.5%, 31.7%, and 27.4%, respectively. The concordance rate between the two techniques was 78.4%.ConclusionThe calibrated pulse-wave analysis and intrapulmonary thermodilution failed to show acceptable interchangeability in terms of both estimating CO and tracking CO changes during living donor liver transplantation.

Deep Learning-Based Stroke Volume Estimation Outperforms Conventional Arterial Contour Method in Patients with Hemodynamic Instability

“…Those pre-existing devices did not show their best performance at the time when they were needed most. We are inclined to place emphasis on the fact that such major fluctuations in vascular tone might negatively influence the performance of the EV1000 method as evidenced by several studies [2,5]. In contrast, within a systemic vascular resistance range of 400 to 1300 dyne∙s/cm 5 , the correlation coefficient was 0.840, which implies that a consistent performance was provided by the DL model.…”

“…Recently, less invasive commercially available arterial pressure waveform-based SV measuring methods (e.g., EV1000; Edwards Lifescience, Irvine, CA, USA) have become popular [2]. The arterial waveform analysis generally is considered to be minimally invasive and provides continuous data that enable a prompt response to be initiated.…”

“…The arterial waveform analysis generally is considered to be minimally invasive and provides continuous data that enable a prompt response to be initiated. However, there have been several concerns regarding such devices, including the need for manual calibration, and unreliable estimation during hemodynamic instability [2,3]. Traditional pressure waveform analysis has been based purely on the morphology of the pressure contour.…”

Non-invasive cardiac output measurement with electrical velocimetry in patients undergoing liver transplantation: comparison of an invasive method with pulmonary thermodilution

“…Whether there is an additional benefit to decision making provided by a PAC over standard care in elderly, high-risk surgical patients requiring intensive care [ 6 – 9 ] is questionable. That said, the importance of intraoperative CO monitoring has led to the development of non-invasive or less-invasive cardiac output monitors, which appear promising as replacements for the thermodilution technique in the intensive care unit; however, none of them can provide adequate precision and accuracy during LDLT [ 10 – 12 ].…”

Cardiac output Optimisation following Liver Transplant (COLT) trial: study protocol for a feasibility randomised controlled trial

“…Measurements of central venous and pulmonary capillary wedge-pressures have traditionally been used to try and identify hypovolaemia post liver transplantation but both values are known to be limited in their ability to do this [ 15 ]. Less invasive pulse-contour analysis devices, such as the FloTrac (EV1000) device, have been used for cardiac output measurement with reasonable accuracy in patients undergoing liver transplantation [ 16 , 17 ]. Whilst there are many donor and recipient factors that contribute to graft and patient survival [ 18 , 19 ], optimal perfusion of the graft is the final common pathway for many of the factors influencing outcome and optimising hepatic blood flow following liver transplant has been shown to result in improved graft function [ 20 ].…”